Male, 73 years old, with hip pain and pain radiating down the back of the leg. History of prostate cancer. A grade 1 retrolisthesis of L4 relative to L5 is demonstrated. Transitional morphology of the L5 vertebral body is seen. Vertebral body heights are preserved. No concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are seen.The spinal canal is congenitally slender in the lumbar region to which prominence of the dorsal epidural fat contributes at several levels. Superimposed upon this are additional degenerative findings as follows:L1-2: Facet arthropathy and ligamentum flavum thickening. Mild disc bulge. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Mild left foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Mild left foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Slight effacement of the lateral recesses but no significant generalized canal stenosis. Moderate left and mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum flavum thickening. Disc bulging with a small right paracentral protrusion. Both lateral recesses are effaced, right side more than left with possible impingement of the descending L5 nerve roots. Moderate to severe bilateral foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal stenosis. Mild right foraminal narrowing.
Disc degeneration and posterior element hypertrophy affect multiple levels as discussed above. No high-grade generalized spinal canal stenosis is seen though some degree of narrowing with crowding of the cauda equina is noted at L1-2 and L2-3. At L4-5, the lateral recesses are narrowed, right side more than left, with possible impingement of the descending L5 nerve roots.Moderate to severe foraminal narrowing is evident bilaterally at L4-5.