Female, 46 years old, with lumbar radicular pain, stool incontinence, subjective right lower extremity weakness. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Endplate edema is seen at L4-5, progressed from prior. Elsewhere, no pathologic marrow replacement or edema is demonstrated. Marrow signal characteristics on T1 and T2-weighted images are slightly dark which may reflect dense bones.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural lesions are detected.At L1-2 through L3-4, no significant spinal canal or foraminal compromise is seen. At most there may be mild facet arthropathy. At L4-5, disc degeneration has progressed with further loss of disc height and progressive endplate edema. However, a large previously demonstrated disc protrusion has significantly regressed with a small residual protrusion in the right paracentral location. This causes focal effacement of the right ventral thecal sac and posterior displacement of the right L5 and S1 nerve roots. Prior generalized spinal canal stenosis has been relieved. The neural foramina are mildly narrowed.At L5-S1, mild facet arthropathy is seen without significant spinal canal or foraminal stenosis.
Although progressive disc degeneration is seen at L4-5 in the form of reduced disc height and worsened endplate edema, a large disc protrusion which previously caused significant spinal canal stenosis has regressed. There is only a small residual right paracentral protrusion which may slightly impinge the right L5 and S1 nerve roots.