Male, 72 years old, bilateral leg pain. Alignment is grossly anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality is seen.The visualized spinal cord and conus are unremarkable. The cauda equina is discussed below.Loss of disk height is evident at L1-2, L2-3 and to a lesser degree at L3-4. Schmorl's nodes are present at L1-2 and L2-3. Additional level specific findings are as follows:T11-12: Central disk protrusion which mildly flattens the ventral cord. No cord edema. No significant generalized canal stenosis. The neural foramina are patent.T12-L1: No spinal canal stenosis or neuroforaminal narrowing. L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a small central protrusion. Moderate generalized spinal canal stenosis. No significant foraminal narrowing.L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disk. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disk. Moderate to severe generalized spinal canal stenosis with some crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with impingement of the cauda equina. Moderate bilateral foraminal narrowing. There is likely a small synovial cyst projecting posteriorly from the right facet joint.L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a left paracentral annular fissure. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Small renal cystic lesions are seen.
Multilevel degenerative findings result in variable spinal canal stenosis, most severely affecting L4-5 where there is a high-grade stenosis with impingement of the cauda equina. Severe foraminal narrowing is seen on the left at L3-4.