Male, 61 years old, with history of non-Hodgkin lymphoma with a CSF protein of 200, moderate stenosis noted on an outside nonenhanced MRI at L3-4. Assess for enhancing nerve roots. Sagittal alignment is grossly anatomic with mild straightening of the lumbar lordosis. Vertebral body heights are preserved. Loss of intervertebral disc height is seen at L4-5 and L5-S1. Advanced endplate degenerative signal abnormality with edema is seen at L4-5. Elsewhere, no significant marrow edema or marrow replacement is seen. No pathologic marrow enhancement is observed.The visualized distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are likewise unremarkable except where influenced by spinal canal stenosis (discussed below). No pathologic spinal cord or nerve root enhancement is seen.L1-2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy with perhaps a small extracanalicular synovial cyst on the left. Mild disc bulging with a superimposed right foraminal/far lateral protrusion. No significant generalized canal stenosis. Mild right foraminal narrowing. L3-4: Moderate facet arthropathy with facet effusions. Ligamentum flavum thickening. Disc bulging. Moderate to severe generalized spinal canal narrowing with crowding of the cauda equina nerve roots and near complete exclusion of CSF. Mild left foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild generalized spinal canal narrowing. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy with a synovial or ligamentum flavum cyst on the right. Disc bulging. No significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing with possible nerve root impingement.
1.No evidence of pathologic spinal cord or nerve root enhancement is seen.2.Multilevel degeneration of the disks and posterior elements is noted. This results in a moderate to severe generalized spinal canal stenosis at L3-4. Severe foraminal narrowing is also evident bilaterally at L5-S1 and on the right at L4-5.