Back pain. A sigmoid shaped lumbar curvature is convex to the right in the upper lumbar region, centered at L2-L3, and convex to the left in the lower lumbar region, centered at L4. This is associated with right lateral translation of L3 relative to L4 as well as mild left-sided L3 and right-sided L4 vertebral body height loss. Sagittal alignment is notable for straightening and minimal posterior subluxation of L3 relative to L4, L4 relative to L5 and L5 relative to S1. Conus is in normal position at the mid L1 level. There is no definite abnormal T2 signal in the conus.There is disc desiccation at the lumbar and included lower thoracic levels associated with severe height loss and degenerative endplate changes and subjacent degenerative marrow changes. This is associated with multilevel degenerative spinal canal stenosis as described below which is superimposed on congenitally, diffusely small lumbar spinal canal. Prominence of the epidural fat also contributes to the stenosis. There is no suspicious marrow signal abnormality.Mild osteoarthritic changes are present at the sacroiliac joints. There is fatty infiltration/atrophy involving the paraspinal muscles.Extensive degenerative changes as described below:T11-T12: There is a right paracentral/foraminal disc protrusion and moderate facet arthropathy. The disc moderately to severely narrows the right side of the spinal canal deforming the conus medullaris but no definite increased cord T2 signal. There is severe right and mild-to-moderate left neural foraminal stenosis.T12-L1: Central/right paracentral disc protrusion resulting in mild right-sided spinal canal stenosis. Moderate facet arthropathy contributes to moderate-to-severe right and mild-to-moderate left foraminal stenosis.L1-L2: Disc bulge is eccentric to the left along with left more than right facet arthropathy result in severe central and left paracentral spinal canal stenosis in addition to moderate-to-severe left and mild right foraminal stenoses.L2-L3: Disc bulge is eccentric to the left and there is moderate-to-severe right worse than left facet arthropathy and moderate ligamenta flava thickening. Combined, these result in severe central spinal canal stenosis and moderate-to-severe left and moderate right foraminal stenoses.L3-L4: Disc bulge is eccentric to the left. There is also moderate facet arthropathy and ligamenta flava thickening. These combined result in severe central and left worse than right paracentral spinal canal stenosis. There is also severe right and moderate left foraminal stenoses.L4-L5: Disc bulge is eccentric to the right. There is right more than left moderate facet arthropathy and moderate ligamenta flava thickening. These result in mild spinal canal stenosis. There is stenosis of the right subarticular recess. There is moderate-to-severe right and mild-to-moderate left neuroforaminal stenoses.L5-S1: The subluxation along with left more than right moderate facet arthropathy results in stenosis of the subarticular recesses. No significant central canal stenosis. There is severe left and moderate right foraminal stenoses.
1.Advanced multilevel degenerative changes superimposed on a congenitally narrow spinal canal and prominence of the epidural fat result in severe spinal canal stenoses from L1-L2 through L3-L4 as described above. There is variable multilevel neural foraminal stenoses, most severe on the right at T11-T12, L3-L4 and L4-L5 and on the left at L1-L2, L2-L3 and L5-S1.2.In addition, T11-T12 disc protrusion mildly deforms the conus medullaris but no definite increased cord T2 signal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.