61-year-old female with worsening back and leg pain. Evaluate for disc pathology.Epic: Pain is localized to the low back and groin, no radiation, no weakness The vertebral column alignment is within normal limits. The vertebral body heights are preserved with mild disc narrowing at L3-L4 and L4-L5. Disc desiccation is present at these levels as well as at L2-L3 and L5-S1. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is developmental narrowing of the distal lumbar spinal canal due to shortened pedicles. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:From T12-L1 through L2-L3, there is facet arthropathy and ligamentum flavum thickening without stenosis.At L3-L4, there is a mild disc bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. There is overall mild central spinal canal stenosis as well as mild right and mild-moderate left foraminal narrowing.At L4-L5, there is a diffuse disc bulge associated with a moderate degree of ligamentum flavum hypertrophy. There is fluid present within the facet joints. The fat at the lateral recesses is effaced bilaterally at this level. There are some mild crowding of the nerve roots within the thecal sac at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L5-S1, there is a stable diffuse disc bulge associated with disc desiccation. There is bilateral ligamentum flavum thickening with narrowing of the lateral recesses. There is overall mild to moderate central spinal canal stenosis as well as moderate right and mild left foraminal narrowing.
Stable degenerative changes in the lumbar spine with moderate spinal stenosis at L4-5 and the mild-to-moderate spinal stenosis at L5-S1.