Female, 71 years old, history of colon cancer with severe right greater than left back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. A left renal cyst is noted incidentally.L1-2: Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L2-3: Mild left facet arthropathy. Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L3-4: Mild bilateral facet arthropathy. Mild disc bulging. No significant compromise of the spinal canal or neural foramina. L4-5: Moderate bilateral facet arthropathy and ligamentum flavum thickening. An extruded or sequestered disc encroaches upon the right lateral recess through the length of the L4 vertebral body. The source of this herniation is difficult to identify with certainty, but it probably arises from the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root is likely displaced and impinged by this process. There is a moderate generalized spinal canal stenosis with some crowding of the cauda equina. There is a moderate to severe stenosis of the right neural foramen. L5-S1: Moderate bilateral facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing.
1.An extruded or sequestered disc is evident effacing the right lateral recess along the L4 vertebral body. The source of this herniation is more likely to be the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root may be displaced or impinged by this process. There is, in addition, a moderate generalized spinal canal stenosis at L4-5.2.Mild degenerative findings are seen at other levels with no additional areas of significant spinal canal compromise.3.No evidence to suggest osseous metastases.