Male, 79 years old, with low back pain, radiculopathy, and lower leg weakness. A trace grade 1 anterolisthesis of L4 relative to L5 is not significantly changed. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous, but there are no areas of significant marrow edema or concerning marrow replacement.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening, progressed from prior. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, progressed from prior. L3-4: Facet arthropathy and ligamentum flavum thickening, progressed from prior. A previously seen synovial cyst projecting into the right lateral spinal canal has since resolved. Progressive loss of disc height and disc bulging is seen. A mild generalized spinal canal stenosis is detected along with moderate bilateral foraminal narrowing, progressed from prior. L4-5: Marked facet arthropathy and ligamentum flavum thickening, progressed from prior. There appears to be a new synovial cyst measuring up to 8 mm projecting into and effacing the left lateral recess (see image 8 series 501, and image 14 series 901). Disc bulging. Significant generalized spinal canal narrowing is seen with effacement of CSF and crowding of the cauda equina nerve roots. Both neural foramina are moderately narrowed. Findings have progressed from prior. L5-S1: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging with a new small superimposed right paracentral protrusion. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing, unchanged.
Progressive degenerative disease is seen at most levels in the lumbar spine. The most severely affected level is L4-5, where facet arthropathy and disc bulging result in a significant generalized spinal canal stenosis with crowding of the cauda equina. In addition, there appears to be a new synovial cyst projecting into the left L4-5 lateral recess. Both neural foramina are moderately narrowed.