Female, 68 years old, with history of spinal stenosis and now worsening pain and one month of urinary incontinence. Concern for cord compression. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The marrow signal characteristics are mildly heterogeneous with a well-circumscribed fatty signal lesion in the L4 vertebral body compatible with a hemangioma. This appearance has not changed from prior.The visualized spinal cord and conus are within normal limits. Details regarding the cauda equina are discussed by level below.Loss of disc T2 signal is evident from L3-4 through L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Moderately sized central disc extrusion extending slightly above and below the level of the adjacent endplates without significant interval change in size. This lesion effaces the ventral thecal sac causing a mild to moderate spinal canal stenosis and displacement of the adjacent cauda equina, again without significant interval change. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed right paramedian protrusion. Mild generalized spinal canal stenosis without cauda equina impingement. No significant foraminal narrowing. No significant interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small annular fissure centrally. Severe generalized spinal canal stenosis with crowding of the cauda equina, perhaps very slightly progressed from prior. Mild bilateral foraminal narrowing. No other significant interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild to moderate generalized spinal canal narrowing without significant change. Mild right and moderate left foraminal narrowing without significant interval change. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Left paracentral disc protrusion, slightly larger than prior. Mild effacement of the left ventral thecal sac, again slightly progressed. Moderate left and mild right foraminal narrowing, unchanged.
1. Stable moderately sized disc extrusion at L1-2 resulting in a stable mild to moderate generalized spinal canal stenosis and displacement of the adjacent cauda equina.2. Possible slight interval progression of severe spinal canal stenosis at L3-4 which is due largely to posterior element hypertrophy.3. Mild interval increase in size of a left paracentral disc protrusion at L5-S1 causing slight progression of thecal sac effacement.4. Relatively mild degenerative findings at other levels are not significantly changed.