Male, 73 years old, with history of spinal stenosis and return of low back pain. A grade 1 anterolisthesis of L4 relative to L5 is seen, probably not significantly changed from prior radiographs. Endplate irregularity and signal alteration, likely degenerative in nature, is seen at L4-5 and to a lesser extent at L5-S1. Otherwise, vertebral body morphology is normal. No worrisome marrow signal abnormality is detected. The visualized spinal cord and conus demonstrate normal signal intensity and morphology. Details of the cauda equina will be discussed below. Near complete loss of intervertebral disc height is seen at L4-5. The remaining discs show relative preservation of height though they have lost their T2 signal. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Moderate bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild to moderate bilateral foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disc uncovering and disc bulging. Prominent ventral epidural fat. Severe generalized spinal canal stenosis with crowding and likely impingement of the cauda equina. Severe left and moderate right foraminal narrowing. L5-S1: Moderate facet hypertrophy with effusions and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Severe bilateral foraminal narrowing.
1.Severe spinal canal stenosis and likely cauda equina impingement at L4-5 due to a combination of disc degeneration, spondylolisthesis and posterior element hypertrophy. Severe left foraminal narrowing is also seen at this level.2.Disc degeneration and posterior element hypertrophy also result in a moderate spinal canal stenosis with crowding of the cauda equina at L3-4.3.Severe bilateral neuroforaminal narrowing is evident at L5-S1.