67-year-old man with history of back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Multiple anterior superior and inferior endplates in the lumbar spine have increased T2 and T1 signal suggestive of fatty degenerative changes. Additionally, there is increased T2 signal and low T1 signal in the anterior inferior endplate of L4, also degenerative. There is disc desiccation with mild height loss at T11/T12, L3/L4, L4/L5, and L5/S1. The conus medullaris is normal in position at L1/L2. Of note, there appears to be congenital narrowing of the mid to distal lumbar spinal canal and prominent posterior epidural fat.Multilevel degenerative changes are seen, as described below:T11-T12: There is a disc bulge with flattening of the left ventral thecal sac but no significant spinal canal or neuroforaminal stenosis.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge along with facet hypertrophy and ligamentum flavum thickening, right greater than left. Additionally, there is a central disc extrusion (201/8) extending cranially approximately 10 mm. This extrusion has slightly increased T2 signal (401/8) compared to the parent disc, suggesting sequestration. There is moderate spinal canal stenosis and narrowing of the lateral recesses, right greater than left. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis. Additionally, the disc bulge impinges on the exiting right L3 nerve root.L4-L5: There is a disc bulge along with facet hypertrophy and ligamentum flavum thickening, right greater than left. Additionally, there is a right distal foraminal/far lateral disc extrusion extending cranially approximately 5 mm, which may also be in early stages of sequestration. There is minimal spinal canal stenosis and narrowing of the lateral recesses. There is moderate to severe right neural foraminal stenosis and mild left neural foraminal stenosis. Additionally, there is impingement on the exiting right L4 nerve root by disc material.L5-S1: There is a disc bulge with facet hypertrophy, left greater than right. There is no significant spinal canal stenosis, however there is bilateral moderate neural foraminal stenosis.There is a presumed left renal cyst partially visualized, as well as a T2 hyperintense lesion in the right aspect of the liver, only partially seen as well. A subcentimeter right retrocrural lymph node is noted. Otherwise the paraspinous soft tissues are within normal limits.
1.Degenerative changes superimposed upon a congenitally narrow canal with prominent epidural fat.2.Small right distal foraminal/far lateral disc extrusion at L4-L5 also possibly in the early stages of sequestration, with moderate-severe right foraminal narrowing and impingement on the exiting right L4 nerve root.3.Large central disc extrusion at L3-L4 with suggestion of sequestration, resulting in moderate central spinal canal stenosis and moderate right foraminal narrowing. Disc material impinges upon the exiting right L3 nerve root.