Female, 70 years old, with low back pain radiating into both lower extremities. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. A focus of fatty signal is seen within the L4 vertebral body likely representing a benign hemangioma. No pathologic marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.Advanced osteoarthritis of the sacroiliac joints is seen. Level specific degenerative findings are as follows:T12-L1: Minimal disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Facet arthropathy, left worse than right. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy, right worse than left. Ligamentum flavum thickening. Minimal disc bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina nerve roots. No significant foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina nerve roots. No significant foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and possible mild compression of nerve roots. Mild left foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc with central annular fissure. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.
Multilevel disc degeneration and posterior element hypertrophy is seen. At L2-3, L3-4 and L4-5, these findings result in spinal canal narrowing, most severely affecting the L4-5 level. At L5-S1, the neural foramina are moderately narrowed. Fairly advanced osteoarthritis of the sacroiliac joints is also seen.