Male, 83 years old, with back pain radiating down the legs. A dextroscoliosis of the lumbar spine is seen with right lateral subluxation of L3 relative to L4. Sagittal alignment is grossly within normal limits. Chronic left lateral wedging of the L1 to L3 vertebrae, and right lateral wedging of L4, is seen related to scoliosis. Otherwise, vertebral body heights are preserved. No evidence of significant marrow edema is seen.The visualized distal spinal cord and conus are within normal limits. Within the right posterolateral spinal canal at the L5-S1 level, there is a collection which measures 20 x 7 mm in the axial plane and 25 mm in the sagittal plane. The collection is T1 and T2 bright with a hypointense circumferential rim and a hypointense internal septation. This collection narrows the thecal sac and displaces the adjacent nerve roots, though the sac was capacious to begin with and there is no significant crowding or impingement of the nerve roots.L1-2: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is relatively unchanged. Mild generalized spinal canal narrowing, particularly affecting the left lateral recess. Moderate left foraminal narrowing, progressed. L2-3: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is unchanged. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing, progressed. L3-4: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Loss of disc height and disc bulging are unchanged. Mild spinal canal narrowing without change. Moderate to severe left foraminal narrowing without change. L4-5: Facet arthropathy and ligamentum flavum thickening without change. Loss of disc height and disc bulging, asymmetric to the right foraminal zone, unchanged. Mild to moderate narrowing of the spinal canal, particularly the right lateral recess, without change. Severe right foraminal narrowing without change. L5-S1: Facet arthropathy and ligamentum flavum thickening, progressed. A dorsally projecting synovial cyst is seen on the right. Disc bulging with progression in the right foraminal zone. Mild spinal canal narrowing due to the right posterolateral collection as above. Severe right foraminal narrowing with likely nerve root impingement, progressed.
A collection is evident within the right posterolateral spinal canal at the L5-S1 level. The collection may be either epidural or subdural in location. Internal signal characteristics suggest that the fluid is proteinaceous or hemorrhagic in nature. The collection does narrow the thecal sac and displace adjacent nerve roots. However, the sac was capacious at this level to begin with and the degree of overall narrowing is mild.Multilevel disc and posterior element degeneration is seen in the context of a scoliotic deformity. Progression of degenerative disease is seen at most levels. Of note, foraminal narrowing is moderate to severe on the left at L3-4, and severe on the right at L4-5 and L5-S1.