Low back pain with pain and numbness radiation into the left L5 distribution. The study is interpreted with the assumption that the last well-formed disc, which also happens to be the most degenerative disc, is at L5-S1. Sagittal alignment is notable for straightening and minimal L2 relative to L3 posterior subluxation associated with mild-to-moderate disc desiccation and height loss. The vertebral bodies are preserved in height. Marrow signal is benign with mixture of type I and type II degenerative marrow signal, most pronounced in relation to the L5-S1 endplates where there is edema in the bone marrow. Milder degenerative marrow changes are present at L3-L4 and L4-L5, where there is disc desiccation and mild height loss. The conus medullaris is unremarkable. The tip of the conus medullaris lies at the lower T12 level. T10-T11 (only on sagittal imaging), T11-T12, T12-L1, and L1-L2: There is no significant spinal canal or foraminal stenosis.L2-L3: The posterior subluxation and associated disc uncovering/bulge result in shallow ventral indentation of the thecal sac but no significant spinal canal or foraminal stenosis.L3-L4: Degenerative disc/endplates along with mild ligamenta flava thickening and right more than left facet arthropathy result in mild central and right more than left paracentral spinal canal stenosis. There is also mild-to-moderate right more than left foraminal stenosis.L4-L5: Degenerative disc disease along with ligamentum flavum thickening result in moderate-to-severe spinal canal stenosis. There is moderate left greater than right foraminal stenosis.L5-S1: There is a small left paracentral disc protrusion narrowing the left subarticular recess. The advanced disc/endplate degenerative disease along with severe left more than right facet arthropathy and severe ligamenta flava thickening result in moderate-to-severe spinal canal stenosis and severe left and moderate to severe right foraminal stenosis. The advanced facet arthropathy is associated with focal T2 hyperintensities that probably represent small synovial cyst projecting posterior to the facet joints.
1.Multilevel degenerative lumbar spondylosis is most pronounced at L5-S1 and L4-5 resulting in moderate-to-severe spinal canal stenosis. There is up to severe left L5-S1 foraminal stenoses. Additional levels as described above.2.For the purposes of numbering the most inferior well-defined disc space is labeled L5-S1.