Low back and right hip pain radiating to groin. Long-term use of prednisone, concern for avascular necrosis versus tendon/ligament damage Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. No evidence of fracture. There is mild reversal of lumbar lordosis. Bone marrow signal is heterogeneous without discrete suspicious osseous lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation and loss of height. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge eccentric to the right. Minimal right greater than left neural foraminal narrowing. No significant central canal stenosis.L3-L4: Disc bulge with left paracentral annular fissure and protrusion resulting in effacement of the left lateral recess. There is mild bilateral neural foraminal stenosis. No significant central canal stenosis.L4-L5: Diffuse disc bulge with right foraminal/extraforaminal disc protrusion and small posterior Schmorl's node involving the right inferior L4 endplate. There is moderate right-sided neural foraminal stenosis and minimal left neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Small central protrusion. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Atrophic native kidneys with small cysts noted.
Overall relatively mild multilevel degenerative changes throughout the lumbar spine as detailed above. There is a right foraminal disc protrusion at the L4-L5 level with moderate right neural foraminal stenosis and possible impingement of the exiting right L4 nerve root. No findings to suggest avascular necrosis involving the lumbar vertebral bodies as questioned.