57-year-old diabetic with new low back pain with left lower extremity weakness and unable to bear weight. Recent fall. Evaluate for epidural abscess and bony involvement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal grade 1 anterolisthesis of L4 on L5. Alignment is otherwise maintained. Bone marrow signal is benign including small focus of T1 hyperintensity at the L4 vertebral body compatible with focal fat or small hemangioma. The conus medullaris is normal in position. No abnormal enhancement or epidural or paraspinous collections.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Mild disk desiccation. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy, left worse than right.L4-L5: Mild disk desiccation. No spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy.L5-S1: Mild disk desiccation. There is a left foraminal and extra foraminal disk protrusion which results in moderate to severe left neural foraminal stenosis. No significant spinal canal or right foraminal narrowing.Paraspinous soft tissues are within normal limits. Multiple cysts are noted in the bilateral kidneys with possible enlargement of the renal calyces, but not well evaluated.
1. No evidence of epidural hematoma or epidural abscess. No compression fractures.2. Disk protrusion at the left L5-S1 level which results in moderate to severe left neural foraminal stenosis and possible impingement of the left L5 nerve root.3. No significant spinal canal stenosis at any level in the lumbar spine.4. Multiple cysts in the bilateral kidneys with questionable dilatation of renal calyces; these findings are not well evaluated on this study and ultrasound can be considered as clinically indicated.