Buttock pain. Radiculopathy, neurogenic claudication. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There are small Schmorl's nodes involving the superior and inferior endplate of L4 with mild associated edema at the superior L4 endplate. There is grade 1 anterolisthesis of L4 and L5 and to a minimal degree also at the L3-L4 level. Alignment is otherwise maintained. There is a nonspecific lesion involving the L2 level with low T1 and low T2 signal. There are multiple additional foci of T1 hyperintensity compatible with foci of fat or small hemangiomas. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge, ligamentum flavum thickening, and moderate facet arthropathy with distention of the facet joints. There is moderate to severe spinal canal stenosis and mild bilateral neural foraminal stenosis.L4-L5: There is disc uncovering as well as right paracentral protrusion which effaces the lateral recesses, right greater than left. There is overall moderate to severe central canal stenosis. There is moderate bilateral facet arthropathy with distention of the facet joints. There is mild bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy with mild facet distention of the left.Small synovial cysts are noted associated with the facet arthropathy at the L3-L4 and L4-5 levels, primarily posterior to the facet joints although there is a tiny, probable synovial cyst in the dorsal epidural space at the L4-L5 level. Paraspinous soft tissues are otherwise within normal limits.
1. Multilevel degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L3-L4 and L4-L5 levels.2. Grade 1 degenerative spondylolisthesis of L4 on L5 and to a lesser degree L3 on L4. Facet arthropathy with distended facet joints at these levels.3. Relatively mild neural foraminal stenoses as described above.