Male, 70 years old, with left lumbar radicular symptoms. Alignment is anatomic. Vertebral body heights are preserved. The marrow signal is diffusely somewhat hypointense on T1 and T2-weighted images but there is no evidence of pathologic edema or STIR hyperintensity. A T1/T2 hyperintense lesion within the L2 vertebral body likely represents a benign hemangioma. Scattered fatty endplate degeneration is also seen most notably at L5-S1.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Disc bulging. Mild spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and bulging disc. Mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. L4-5: Facet arthropathy. Bulging disc. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging with a superimposed central protrusion. Moderate spinal canal stenosis. Severe right and moderate left foraminal narrowing.
Multilevel disc and posterior element degeneration is seen. The L2-3 level is most significantly affected where there is a moderate spinal canal stenosis with crowding of the cauda equina. Significant foraminal narrowing is also demonstrated on the left at L3-4 and on the right at L5-S1.Diffuse hypointense marrow signal may represent normal variation or marrow reconversion due to anemia or chronic illness. No focally aggressive lesions are seen.