Low back pain with radiation into the right leg. Evaluate for discitis. There is minimal retrolisthesis of L3 relative to L4. There is minimal fat along the filum terminale. The conus medullaris and the included caudal spinal cord display normal signal. The vertebral body heights are preserved. However, Schmorl nodes are present along the inferior endplates of L3, L4 and L5, with the largest being at L4 right posterolaterally. These are associated with heterogeneous, contrast enhancing, edema-like marrow signal. The tip of the conus medullaris is at L1-L2 level. There is diffuse congenital narrowing of the spinal canal with superimposed focal degenerative spondylosis. At L2-L3, a disc bulge is eccentric to the left causing mild-to-moderate left and mild right neural foraminal stenoses. At L3-L4, a disc bulge and uncovering along with ligamenta flava thickening and facet arthropathy result in mild spinal canal stenosis, as well as mild-to-moderate neural foraminal stenosis. At L4-L5, a disc bulge, moderate ligamentum flavum thickening, and severe right and mild left facet arthropathy result in moderate central and right paracentral spinal canal stenosis. There is also severe right and mild to moderate left neural foraminal stenoses. There is enhancement involving the right L4-L5 facet associated with subjacent bone marrow edema, which also involves the neural foramen. At L5-S1, a disc bulge along with mild facet arthropathy result in mild narrowing of the right subarticular recess. There is also severe right and moderate left neural foraminal stenosis at this level.
1. Multilevel degenerative spondylosis associated with congenital spinal canal stenosis is most pronounced at L4-L5, where there is severe right foraminal stenosis and as moderate central and right paracentral spinal canal stenosis, as well as severe right and moderate left neural foraminal stenosis at L5-S1 and moderate right L3-L4 neural foraminal stenosis.2. Multiple Schmorl nodes with associated edema involving the L3, L4, and L5 vertebral bodies.