Radicular pain in the L4 distribution on the right side. Evaluate for lumbar spinal stenosis or herniated disc. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spine and minimal retrolisthesis of L2 on L3 and L5 on S1. Bone marrow signal is benign with scattered foci of T1 hyperintensity likely representing foci of fat and small hemangiomas. There is loss of disc height at multiple levels, relatively worse at the L5-S1 level with adjacent endplate fatty marrow signal changes on a degenerative basis. The conus medullaris is normal in position.Small disc bulges in the lower thoracic spine are partially imaged. Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: Mild disc bulge and prominence of the dorsal epidural fat without significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with prominence of the epidural fat, ligamentum flavum thickening, and bilateral facet arthropathy result in mild spinal canal stenosis. There is also mild left and minimal right bilateral neural foraminal narrowing.L3-L4: Minimal disc bulge eccentric to the right with ligamentum flavum thickening and minimal facet arthrosis. No significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L4-L5: There is soft tissue dorsal to the L4 vertebral body most likely representing extruded disc material, likely originating at L4-5 with superior migration to the upper/mid L4 level. There is complete effacement of the right lateral recess from the upper L4 to the L4-L5 level. There is also moderate central canal stenosis with mass effect on the cauda equina nerve roots in the right aspect of the thecal sac. There is also moderate right neural foraminal stenosis related to eccentric disc herniation on the right. Minimal left neural foraminal narrowing. Bilateral facet arthropathy. L5-S1: Disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is partial effacement of the bilateral lateral recesses. No significant central canal stenosis. There is moderate bilateral neural foraminal stenosis.Bilateral renal cysts are noted. Paraspinous soft tissues are unremarkable.
Multilevel degenerative changes in the lumbar spine as detailed above including a large disc extrusion at the right L4-L5 level with superior migration to the upper/mid L4 level. There is likely associated impingement of the right L4 nerve root in the lateral recess and neural foramen. There may also be impingement of the right L5 nerve root and additional lower cauda equina nerve roots related to moderate central canal stenosis at the L4/L4-L5 level related to the disc extrusion.