Back pain with radicular pain. Rule out lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. There is a chronic appearing compression fracture involving the superior endplate of the L4 vertebral body with approximately 30% loss of height involving the right aspect of the vertebral body. No edema involving the bone marrow. Remainder of the vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and L4 on 5. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level. There is fatty infiltration involving the filum terminale from the L2 level to the sacrum measuring 1 to 2 mm.There is developmental narrowing of the lumbar spinal canal and epidural lipomatosis resulting in moderate L2-L3, severe L3-L4, and moderate to severe L4-L5 spinal canal stenosis. There are additional multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is moderate spinal canal stenosis primarily related to developmental narrowing and epidural lipomatosis. Neural foramina are patent.L3-L4: Disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is severe spinal canal stenosis related to developmental narrowing and epidural lipomatosis with superimposed aforementioned degenerative changes. Mild bilateral neural foraminal narrowing, relatively worse on the right.L4-L5: Disc bulge with advanced facet arthropathy and prominent ligamentum flavum thickening. There is also prominence of the epidural fat. There is resulting moderate to severe spinal canal stenosis. Mild right and mild to moderate left neural foraminal stenosis. Distention of the facet joint on the right.L5-S1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. Mild spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.
1. There is severe L3-L4 and moderate to severe L4-L5 spinal canal stenosis related to combination of developmental narrowing, epidural lipomatosis, and superimposed degenerative changes. There is no high-grade neural foraminal stenoses at any level although there is mild or mild-to-moderate multilevel foraminal stenoses. Please see additional details above.2. Prominent facet arthropathy from L3-L4 to L5-S1. Minimal anterolisthesis of L3 on L4 and L4 and 5.3. Fatty infiltration of the filum terminale with normal conus position.4. Chronic mild compression fracture involving the L4 vertebral body without bone marrow edema.