Reason: rule out lumbar radiculopathy. hx of prostate cancer with radiation Rx History: L sciatica but sensory problems in both legs and pain in L paraspinal region Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis as well as grade 1 anterolisthesis of L2 on L3 and mild retrolisthesis of L3 on L4. There is also grade 2 anterolisthesis of L5 on S1. The conus medullaris is normal in position. No suspicious lesions are seen in the spine to suggest metastatic disease. No abnormal enhancement in the epidural space or of the cauda equina nerve roots. Perineural cysts noted in the sacrum at the S2 level. There is T1 shortening involving the lower lumbar spine and sacral bone marrow consistent with history of prior radiation.There is osseous fusion involving the L4-L5 disc space. There is multilevel disc height loss, particularly the L3-L4 and L5-S1 levels and to a lesser degree L2-L3 level. There are degenerative endplate marrow signal changes as well as vacuum phenomena at these disc spaces. Small Schmorl's nodes are also evident.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis.L1-L2: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and moderate facet arthropathy. Grade 1 anterolisthesis as mentioned above. There is mild to moderate spinal canal stenosis. There is mild bilateral neural foraminal narrowing.L3-L4: Disc bulge, facet arthropathy, ligamentum flavum thickening result in effacement of the lateral recesses as well as mild central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Fusion across the disc space as mentioned above. There is effacement of the lateral recesses without significant central canal stenosis. There is mild right greater than left neural foraminal stenosis. L5-S1: Grade 2 anterolisthesis with advanced bilateral facet arthropathy. There is disc uncovering and mild bulge extending to the neural foramina. There is no significant central canal stenosis. There is effacement of the bilateral lateral recesses. There is moderate to severe right and severe left neural foraminal stenosis where there may be impingement of the exiting L5 nerve roots.Paraspinous soft tissues are within normal limits. Bilateral renal cysts are seen, including a relatively larger one on the right measuring approximately 5 cm in diameter.
1. Multilevel degenerative changes in the lumbar spine as detailed above. There is mild to moderate L2-L3 and mild L3-L4 central canal stenosis. There is also multilevel neural foraminal narrowing, which is severe at the L5-S1 level where there may be impingement of the L5 nerve roots, particularly on the left. There is also grade 2 anterolisthesis at this level. Additional levels as above.2. No findings to suggest metastatic disease in the lumbar spine.