Male, 67 years old, with low back pain radiating to the feet, right more than left. The last vertebral body bearing well-formed ribs will be considered T12. This implies 6 lumbar type vertebral bodies with a mildly transitional morphology of L6.Slight retrolisthesis of L3 relative to L4 and L4 relative to L5. A grade 1 anterolisthesis of L5 relative to L6 is also seen.Vertebral body heights are preserved. Marrow signal characteristics are remarkable for scattered endplate degenerative signal change and scattered Schmorl's nodes at lower levels. No worrisome marrow replacement or significant marrow edema is seen.The visualized spinal cord and conus are within normal limits. Details of the cauda equina are discussed below.The intervertebral discs show diffuse loss of T2 signal and moderate loss of height at L3-4, L4-5 and L5-6. Additional level specific findings are as follows:T11-12: Ligamentum flavum hypertrophy on the left causing mild left foraminal narrowing.T12-L1: No significant spinal canal or foraminal stenosis.L1-2: Anterior osteophytosis, but no significant spinal canal or neuroforaminal stenosis. L2-3: Right lateral disc osteophyte formation. Mild right foraminal narrowing. No significant spinal canal stenosis. L3-4: Mild facet hypertrophy. Congenitally shortened pedicles. Prominence of the epidural fat. Mild disc bulging. Findings contribute to produce a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. The neural foramina are moderately narrowed. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Congenitally shortened pedicles. Prominence of the epidural fat. Disc bulging. Findings contribute to produce a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. Moderate to severe bilateral foraminal narrowing. L5-L6: Marked facet hypertrophy. Ligamentum flavum thickening. Congenitally shortened pedicles. Disc bulging. Prominence of the epidural fat. Findings contribute to produce a severe spinal canal stenosis with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L6-S1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.
A combination of findings, including posterior element hypertrophy, prominence of the epidural fat, disc bulging and congenitally shortened pedicles, contribute to produce significant spinal canal stenoses at L3-4, L4-5, and L5-6. Scattered foraminal narrowing is also demonstrated, most severely affecting the L4-5 level.