Diagnosis: Spinal stenosis, lumbar regionClinical question: eval for nerve compression. Possibly L4-L5Signs and Symptoms: l gluteal and low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a mild sigmoid curvature to the lumbar spine with mild dextrocurvature to the lower lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, diffuse disc bulge and mild facet hypertrophy at this level.At L4-5 there is loss of disc space height, marked bilateral facet and ligamentum flavum hypertrophy and approximately 6 mm anterior subluxation of L4 on L5. The exiting nerve roots within the neural foramina are surrounded by fat. There is effacement of fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level.
There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is anterior subluxation of L4 and L5 associated with facet hypertrophy and moderate spinal stenosis.