Asymmetric patellar reflexes with decreased reflexes over left patella. Lumbar radiculopathy. Right leg pain. Please note there is variant lumbosacral anatomy and for the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. As numbered there appears to be hypoplastic ribs associated with L1. Vertebral body heights are normal. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign. Conus is in normal position. There are multilevel degenerative changes with disc desiccation from L2-L3 to L5-S1 with minimal loss of height. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: There is mild disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: There is bilateral facet arthropathy and grade 1 anterolisthesis. There is disc uncovering and minimal bulge. There is minimal central spinal canal narrowing. There is mild to moderate right and moderate to severe left neural foraminal stenosis where there may be impingement of the left exiting L4 nerve root. L5-S1: There is disc bulge and advanced bilateral facet arthropathy. There is severe right and moderate left neural foraminal stenosis. There is partial effacement of the right lateral recess. No significance central canal stenosis.Postcontrast sequences demonstrate enhancement associated with the left L4-L5 and L5-S1 facet arthropathy most likely on a degenerative basis. There is enhancement of the left foraminal L4 and right L5 nerve roots which is most likely related to the proximal stenoses. There is also mild enhancement involving the cauda equina nerve roots/dorsal dural surface at the L4-L5 level which are of uncertain significance but may be related to the adjacent L4-L5 facet arthropathy, spinal stenosis--although it is relatively mild, or less likely a separate inflammatory process.
1. Degenerative changes in the lumbar spine, particularly at the L4-L5 and L5-S1 levels. There is grade 1 L4-L5 anterolisthesis. There is up to moderate to severe neural foraminal stenosis on the left at L4-L5 and on the right at L5-S1 where there may be impingement of the left L4 and right L5 exiting nerve roots. Additional levels as above.2. There is enhancement involving and surrounding the left L4 foraminal nerve root as well as the right L5 nerve root which is most likely on a degenerative/compressive basis. There is also subtle enhancement involving the cauda equina nerve roots at the L4-L5 level which may be on a degenerative basis/reactive process; a separate inflammatory process involving the cauda equina nerve roots is felt to be less likely but not entirely excluded. 3. Please note comment regarding lumbosacral vertebral numbering above.