Male, 56 years old, with severe degenerative disease presenting with bilateral lower extremity pain, numbness and tingling, chronic for one year, with new knee buckling. Sagittal alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate edema is seen at L3-4. A benign hemangioma is evident within the left aspect of the L1 vertebral body. Elsewhere, no significant marrow signal abnormality is detected. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal stenosis with near complete effacement of the CSF and crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a superimposed central disc protrusion. Severe spinal canal stenosis with effacement of the CSF and likely impingement of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a right paracentral protrusion. Moderate generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the left. No spinal canal stenosis. Moderate left and mild right foraminal narrowing.
1.Disc degeneration at L3-4 along with posterior element hypertrophy contribute to produce a severe spinal canal stenosis with impingement of the cauda equina.2.Left severe spinal canal narrowing is evident on the right at L4-5.3.Severe foraminal narrowing is seen on the right at L4-5. Scattered mild-to-moderate foraminal narrowing is evident as discussed above.