80 yo female with neurogenic claudication, back pain and leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild retrolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign with prominent type I Modic/edematous bone marrow signal changes involving the inferior L4 and superior L5 endplates. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk desiccation and bulge and ligamentum flavum thickening. Minimal spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L3-L4: There is loss of disk height with mild T2 hyperintensity likely on a degenerative basis. There is severe spinal canal stenosis related to disk bulge, bilateral ligamentum flavum thickening, and facet arthropathy. There is moderate right and moderate to severe left neural foraminal stenosis.L4-L5: There is loss of disk height with minimal T2 hyperintensity likely on a degenerative basis. There is marked spinal canal stenosis related to right central and foraminal disk extrusion, facet arthropathy, and ligamentum flavum thickening. There is severe right neural foraminal stenosis and mild left neural foramina narrowing.L5-S1: Minimal disk bulge, eccentric to the right with minimal right neural foraminal narrowing. Otherwise no significant spinal canal or left neural foramina narrowing. Multiple facet arthropathy with mild distention of the facet joints. Small bilateral renal cysts. Paraspinous soft tissues are within normal limits.
1. Multilevel degenerative changes which are advanced at L3-L4 and L4-L5. There is severe spinal canal stenosis at L3-L4 and L4-L5.2. Severe right L4-L5 neural foraminal stenosis and at least moderate bilaterally at L3-L4 , as detailed above.3. Mild retrolisthesis of L4 and L5.