Female, 61 years old, bilateral lower extremity radiculopathy. A dextroscoliosis of the lumbar spine is noted. Trace grade 1 anterolisthesis of L4 relative to L5 is also seen. Vertebral body height is preserved.From scattered endplate degenerative signal change and mild marrow heterogeneity, no pathologic marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. Multiple perineural root sleeve cysts are seen expanding the sacral foramina.T11-12: Facet arthropathy, right worse than left. Disc bulging with a left central/foraminal protrusion. No significant generalized spinal canal stenosis. No significant foraminal narrowing.T12-L1: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Left facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy. Mild disc bulging. Mild spinal canal narrowing. Mild left foraminal narrowing. L3-4: Facet arthropathy. Bulging disc. Moderate spinal canal narrowing with slight crowding of the cauda equina. Moderate to severe bilateral foraminal narrowing. L4-5: Marked facet arthropathy with facet effusion on the left. Bulging disc. Moderate spinal canal narrowing. Severe right foraminal narrowing with possible nerve root impingement. L5-S1: Marked facet arthropathy, right worse than left. Mild disc bulging. No significant generalized spinal canal stenosis. However, a 6 mm probable cystic structure projects into spinal canal from the right facet joint which appears to contact the transiting right S1 nerve root. Significant right foraminal narrowing with possible nerve root impingement.
Multilevel disc and posterior element degeneration is seen. Findings are most severe at L3-4 and L4-5 where there is moderate to severe spinal canal narrowing. Severe foraminal narrowing is evident on the right L4-5, and on the right at L5-S1, with possible associated nerve root impingement. A probable synovial cyst projects medially into the spinal canal from the right L5-S1 facet joint contacting the transiting right S1 nerve root.