Female, 71 years old, with persistent back pain and radiation to the left leg. Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or edema is demonstrated. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. Focal volume loss and scarring of the left kidney are seen, stable from prior 2008 CT.L1-2: Unremarkable. L2-3: Facet hypertrophy and ligamentum flavum thickening. Left disc height with disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild loss of disc height with disc bulging. Moderate spinal canal stenosis with slight crowding of the cauda equina. Severe right and moderate left foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Disc bulging. Posterior spinal canal stenosis with crowding of the cauda equina. Severe bilateral foraminal narrowing. L5-S1: Advanced facet hypertrophy and ligamentum flavum thickening. Disc bulging asymmetric to the left with a left paracentral protrusion. No significant spinal canal stenosis. Severe left foraminal narrowing. Mild right foraminal narrowing.
Multilevel disc and posterior element degeneration is seen. Specifically, there is moderate spinal canal stenosis at L3-4 with severe right-sided foraminal narrowing; severe spinal canal stenosis at L4-5 with severe bilateral foraminal narrowing; and severe left foraminal narrowing at L5-S1.