Saddle distribution pain and paresthesia. There is 50% anterior/central vertebral body height loss at L2 associated with minimal, if any, adjacent marrow edema. There is no retropulsion or extraosseous soft tissue component. The vertebral bodies are preserved in height otherwise and there is no suspicious marrow edema. Mild type I degenerative signal is present subjacent to the endplates of L5-S1 anteriorly. There is severe disc height loss at L3-L4, L4-5 and L5-S1. Sagittal alignment is notable for straightening in addition to minimal anterior subluxation of L1 relative to L2 and L2 relative to L3 and posterior subluxation of L3 over L4. The spinal canal is severely narrowed at L2-L3 as described below with redundant cauda equina roots cranial to the stenosis level. The conus medullaris tip lies at L1-L2 level. The conus has a normal morphology and signal. There are well-circumscribed, homogeneously T2-hyperintense, T1-hypointense renal lesions, the largest of which is an exophytic lesion arising from the inferior pole of the left kidney that measures up to 5.2 cm. These are likely cysts but are not completely assessed. At T10-T11, there is central/left paracentral disc protrusion and mild facet arthropathy but no significant spinal canal or neural foraminal stenosis. At T11-T12, there is a small central disc protrusion and mild facet arthropathy but no significant spinal canal or neural foraminal stenosis. At T12-L1, there is a tiny left paracentral disc protrusion as well as moderate facet arthropathy and ligamentum flavum thickening but no significant spinal canal or neural foraminal stenosis. At L1-L2, the subluxation-associated disc uncovering/bulge and severe bilateral facet arthropathy result in moderate central and left paracentral spinal canal stenosis. There is minimal, if any, left-sided neural foraminal stenosis. At L2-L3, the subluxation-associated disc uncovering along with disc bulging and severe bilateral facet arthropathy and ligamenta flava thickening result in severe spinal canal stenosis. There is moderate-to-severe left and moderate right medial neural foraminal stenoses. A small, heterogeneously T2-hyperintense lesion related to the right facet is probably a synovial cyst. At L3-L4, disc osteophyte complex and moderate bilateral facet arthropathy result in stenosis of the right subarticular recess and mild central spinal canal stenosis. There is also severe right and moderate left neural foraminal stenoses that are most pronounced medially. A large right lateral osteophyte also touches the right L3 nerve root. At L4-L5 and L5-S1: There is no significant central spinal canal stenosis, but there is severe left and moderate-to-severe right neural foraminal stenoses caused by the facet arthropathy and the disc/osteophyte. The lateral osteophytes at L5-S1 contact the respective extraforaminal segments of the L5 nerve roots.
1.A compression fracture of L1 likely represents a chronic insufficiency fracture. 2.Multilevel degenerative lumbar spondylolysis with spinal canal stenosis that is severe at L2-L3 and moderate at L1-L2, as well as bilateral neural foraminal stenoses that are most pronounced at L4-L5 and L5-S1.3.Multiple renal cysts are not completely assessed on this examination. A renal ultrasound may be useful for further evaluation.