63-year-old female with a history of spinal stenosis and back pain with sciatica. Evaluate for spinal stenosis. The vertebral column alignment is within normal limits. There is mild loss of vertebral body height involving the superior endplate of L1 with evidence of Schmorl's nodes. There is variable disc height loss with disc desiccation involving the T12-L1, L4-5 and L5-S1 discs. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is a mild disc bulge but no significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is a left greater than right disc bulge and mild-moderate facet arthropathy with ligamentum flavum thickening which contributes to moderate spinal canal stenosis as well as mild right and moderate left neuroforaminal narrowing. There is also mild left and moderate right lateral recess stenosis. There is a small effusion involving the left L3-4 facet joint.L4-5: There is a disc bulge with a large left paracentral disc extrusion which along with facet arthropathy and ligamentum flavum thickening results in severe spinal canal stenosis and moderate bilateral neuroforaminal narrowing. There is also severe left and moderate to severe right lateral recess stenosis. L5-S1: There is a small disc bulge, facet arthropathy and ligamentum flavum thickening but no significant compromise of the spinal canal or neuroforamina.Incidentally seen left renal cystic lesions likely represent benign renal cysts.
Multilevel spondylotic changes most prominent at the L4-5 level where a large left paracentral disc extrusion contributes to severe spinal canal stenosis, severe left and moderate-severe right lateral recess stenosis, and moderate bilateral neuroforaminal narrowing.