Female, 91 years old, with pain in the right iliac crest/sciatic region and pain in the right lower extremity. A mild sclerotic curvature of the lumbar spine is demonstrated. Vertebral bodies are otherwise well aligned with respect to each other.Marrow signal characteristics are heterogeneous, particularly at L4-5 where there is superimposed degenerative endplate signal abnormality. No areas concerning marrow replacement are detected.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.Disk degeneration is evident at every level with loss of disk height most severely affecting L4-5. Additional levels specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. Mild spinal canal stenosis. Moderate left and mild right foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with crowding of the cauda equina. Mild right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with crowding of the cauda equina. Severe left and moderate to severe right foraminal narrowing. L5-S1: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant spinal canal or foraminal stenosis. A large right renal cyst is demonstrated.
Multilevel degenerative findings are seen involving the disk spaces and posterior elements. The L3-4 and L4-5 levels are most significantly affected with severe spinal canal stenosis and crowding/impingement of the cauda equina. Significant bilateral foraminal narrowing is also evident at L4-5.