Female, 44 years old, with urinary incontinence and weakness. Thoracic:Exaggerated kyphosis in the mid to lower thoracic spine likely reflects endplate irregularities and slight anterior wedging from T6 through T11. Sagittal alignment is otherwise unremarkable.Otherwise, vertebral body morphology is unremarkable. Vague enhancement seen within the T11 vertebral body. Elsewhere, vertebral body signal characteristics are unremarkable.The dorsal epidural fat is prominent throughout much of the thoracic spine, but most notably from T4 through T9. This results in a generalized narrowing of the thecal sac. There is complete effacement of the CSF space and potentially some mass effect upon the spinal cord in this region. Contributing to this appearance is severe facet hypertrophy and ligamentum flavum thickening bilaterally at T4-5, on the right at T5-6, and bilaterally at T6-7. Significant foraminal narrowing is seen on the left at T4-5-7, and on the right at T4-5, T5-6 and T6-7.No convincing evidence of any spinal cord signal abnormality is seen. No pathologic intracanalicular enhancement is seen.Lumbar:Spinal alignment is anatomic. Allowing for degenerative irregularity and signal change at L5-S1, vertebral body morphology and marrow signal characteristics are unremarkable. The L5 and S1 endplates are enhancing which is likely degenerative in nature. No other pathologic marrow enhancement is seen.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal narrowing. Mild right foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a large superimposed central disc extrusion which projects inferiorly and extends nearly to the S1 to disc bulge. Extrusion causes a severe narrowing of the central spinal canal and likely impingement of the multiple sacral nerve roots. Moderate bilateral foraminal narrowing.
1.Prominence of the dorsal epidural fat is seen in the thoracic region, most conspicuously between T4 and T9. This, along with posterior element hypertrophy, causes a significant narrowing of the thecal sac with complete effacement of the CSF. The spinal cord itself may be slightly compressed by this process though there is no evidence of cord edema. Prominent epidural fat is often an incidental finding, though on occasion it can produce symptomatology.2.Exaggerated kyphosis in the mid to lower thoracic spine in association with endplate irregularity and mild anterior wedging from T6 through T11 may reflect Scheuermann's disease.3.A large inferiorly directed central disc extrusion at L5-S1 is seen, resulting in significant encroachment upon the central spinal canal and likely impingement of multiple sacral nerve roots.4.Enhancement within the T11 vertebral body is seen, a nonspecific finding which may represent a slightly atypical presentation of hemangioma.