Back pain radiating to legs. 46-year-old with history of back surgery presenting with back pain and possible radiation down leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Ventral bridging osteophytes in the lower thoracic spine suggestive of diffuse idiopathic skeletal hyperostosis better imaged on prior abdominal CT.There is developmental narrowing of the mid to lower lumbar spinal canal with superimposed degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: There is bilateral facet arthropathy, ligamentum flavum thickening, and minimal disc bulge superimposed on developmental narrowing and resulting in mild to moderate spinal canal stenosis. Neural foramina are patent. There is mild edema associated with the right L3-L4 facet arthropathy involving the adjacent soft tissues. T2/STIR hyperintensity involving the bone marrow of the right L4 pedicle and right L3 inferior articular facet may also be reactive. There is 4 x 6 mm focus of fluid posterior inferior to the facet joint, series 8 axial image 18.L4-L5: There is mild to moderate spinal canal stenosis which is predominantly on a developmental basis, with prominence of the epidural fat and bilateral facet arthropathy, ligamentum flavum thickening, and minimal disc bulge also present. Mild narrowing of the left neural foramen. Right neural foramen is patent.L5-S1: No significant disc disease. Thecal sac tapers at this level. No spinal canal or neural foraminal stenosis.
1. There is mild to moderate degree of spinal canal stenosis at the L3-L4 and L4-L5 levels which is predominantly on a developmental basis. There are mild superimposed degenerative changes.2. Multilevel facet arthropathy, relatively worse at the right L3-L4 level, which may be contributing to patient's low back pain. There is mild edema/inflammatory change surrounding the right L3-L4 facet joint with subcentimeter fluid collection in the soft tissues posterior inferior to the facet joint. These findings indicating inflammation are nonspecific and infection should be considered in the appropriate clinical setting.