Low back pain with physical exam indicating facet arthropathy and lumbar x-ray with severe degenerative disease at L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild dextrocurvature of the lumbar spine. There is also grade 1 anterolisthesis of L4 and L5 and minimal retrolisthesis of L5 on S1. Bone marrow signal is benign. The conus medullaris is normal in position. There is haziness involving the CSF on the sagittal T2 sequences in the upper and mid aspect of the lumbar spinal canal likely reflective of nerve root redundancy and vascular congestion related to spinal canal stenosis described below. Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge and bilateral facet arthropathy. No spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild narrowing of the spinal canal and neural foramina.L3-L4: Disc bulge, ligamentum flavum thickening, facet arthropathy, and prominence of the epidural fat resulting in moderate spinal canal stenosis. There is mild to moderate right and moderate left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis, disc bulge, ligamentum flavum thickening, advanced bilateral facet arthropathy, and prominence of the dorsal epidural fat. There is moderate spinal canal stenosis. Moderate left greater than right bilateral neural foraminal stenosis.L5-S1: Severe loss of disc height, vacuum phenomena, and subchondral cyst formation along the endplates. There is a disc bulge with a right paracentral disc protrusion component. There is bilateral facet arthropathy. There is effacement of the right lateral recess. Mild narrowing of the central canal. There is moderate right and mild to moderate left neural foraminal stenosis.
1. Multilevel degenerative changes in the lumbar spine with moderate spinal canal stenosis at the L3-L4 and L4-L5 levels related to degenerative changes and prominence of the dorsal epidural fat.2. Multilevel neural foraminal stenoses as described above.3. Advanced facet arthropathy at the L4-L5 and L5-S1 levels. Advanced disc-endplate degenerative changes at the L5-S1 level.