Back pain with radiation to the left leg. The patient is noted to have transitional spinal anatomy and for the purposes of numbering, there are 6 lumbar type vertebral bodies. The last fully formed disc is designated as L6-S1.There is mild anterolisthesis of L5 on L6. The lumbar spine is otherwise in normal alignment with a normal lumbar lordosis. There is mild narrowing of the intervertebral discs at the L3-4, L4-5, and L5-6 levels, and likely developmental at L6-S1. The vertebral body heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. There is scattered disc desiccation.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is minimal shallow left paracentral disc protrusion without significant compromise to spinal canal or neural foramina.L3-L4: There is mild disc bulge with mild narrowing of the spinal canal and bilateral neural foramina with thickening of the ligamentum flavum.L4-L5: There is moderate disc bulge with moderate narrowing of the spinal canal. There is also superimposed left neural foraminal disc extrusion which migrates cranially approximately 8 mm, resulting in severe left-sided neural foraminal stenosis. There is also a right paracentral sequestered disc fragment of differential signal from the parent disc, which measures 12 x 6 mm in the greatest axial dimension and 14 mm in the craniocaudal dimension. The fragment extends along the upper L5 vertebral body. This fragment appears to abut and minimally displace the descending right L5 nerve root. There is moderate right neural foraminal stenosis. Additionally, there is thickening of the ligamentum flavum and bilateral facet arthropathy.L5-6: There is mild anterolisthesis of L5 on L6 with uncovering of the disc at this level. There is moderate disc bulge with moderate narrowing of the spinal canal and mild bilateral neural foraminal stenosis. There is bilateral facet arthropathy, right greater than left. There is thickening of ligamentum flavum. There is a central annular fissure with shallow central disc protrusion.L6-S1: There is no significant compromise to spinal canal or neural foramina.
1. Transitional anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended. 2. Multilevel degenerative changes as detailed above with disc extrusion at the L4-5 level resulting in severe left neural foraminal stenosis which may be accounting for the patient's symptoms. Additional right paracentral sequestered fragment at this level which abuts the descending right L5 nerve root.3. Mild degenerative anterolisthesis of L5 on L6.