Evaluate for cord compression; back pain, weakness Examination is motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis. Bone marrow signal is benign. There is disc desiccation at L2-L3, L3-L4, L4-L5, and L5-S1 levels with endplate marrow changes at the L4-L5 levels. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with mild effacement of the lateral recesses. No significant central spinal canal stenosis or neural foraminal stenosis.L3-L4: Minimal disc bulge and central protrusion. No significant central spinal canal stenosis or neural foraminal stenosis. L4-L5: Large disc extrusion with inferior migration of approximately 2 cm and complete obliteration of the thecal sac at this level. Minimal left neural foraminal narrowing.L5-S1: Minimal disc bulge no significant spinal canal narrowing. Minimal bilateral neural foraminal narrowing.Paraspinous soft tissues are within normal limits.
Large disc extrusion at the L4-L5 level with associated high-grade spinal canal stenosis and likely impingement of the cauda equina nerve roots.