Back pain, left-sided sciatica, metastatic breast cancer Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4. Alignment is otherwise maintained. The conus medullaris is normal in position. Bone marrow signal is heterogeneous with multiple small T1 hypointense lesions consistent with known metastatic disease, as demonstrated on prior bone scan and CT studies. Relatively more prominent lesion is seen involving the left L2 pedicle and transverse process. No lesions with enhancement are demonstrated. There is no evidence of epidural tumor. No large osseous lesions or pathologic compression fractures are demonstrated. Multilevel degenerative changes are seen including severe loss of disc height at the L4-L5 levels with associated endplate edema at L4 and L5. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligament flavum thickening, and facet arthropathy resulting in mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is grade 1 anterolisthesis, disc bulge, ligamentum flavum thickening, and advanced facet arthropathy with severe spinal canal stenosis at this level. There is mild to moderate left and minimal right neural foraminal narrowing. Fragmentation involving the left facets noted. There are inflammatory changes surrounding the left facet joint with edema and enhancement.L4-L5: Significant loss of disc height, vacuum phenomenon, and disc and endplate edema which are likely on a degenerative basis. There is mild disc bulge, facet arthropathy, and ligamentum flavum thickening. There is resulting moderate spinal canal stenosis. There is also mild right and moderate left neural foraminal stenosis. L5-S1: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.
1. Multiple small osseous lesions without enhancement corresponding to sclerotic foci demonstrated on recent CT and better assessed on prior bone scan studies. There are no large lesions, pathologic fractures, or evidence of epidural tumor.2. Advanced degenerative changes with severe spinal canal stenosis at the L3-L4 level and to a lesser degree at the L4-L5 level. Neural foraminal narrowing as above including moderate left L4-L5 neural foraminal stenosis which may be impinging on the exiting left L4 nerve root. Mild to moderate left L3-L4 neural foraminal narrowing is also seen.3. Degenerative facet arthropathy at multiple levels with inflammatory changes noted surrounding the left L3-L4 facet joint.