Female, 67 years old, with bilateral lower back pain radiating to the lower extremities. With neck pain and myelopathy, new acute. Cervical spine:Mild reversal of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Endplate edema is seen at C4-5 and to a lesser degree at C3-4, progressed from prior. No worrisome marrow replacing lesions are demonstrated. The visualized spinal cord shows normal signal intensity throughout. No epidural lesions are suspected.C2-3: Facet arthropathy, left more than right. No significant spinal canal or foraminal compromise. No interval changes.C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left. Mild spinal canal narrowing. Severe left foraminal narrowing. No interval changes. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate spinal canal narrowing. Severe left and mild right foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Severe left foraminal narrowing. No interval changes. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Mild left foraminal narrowing. No interval changes. C7-T1: Facet arthropathy. No significant spinal canal or foraminal compromise. No interval changes. As visualized on sagittal images, disc bulging at T2-3 is probably not significantly changed with resultant foraminal narrowing.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized distal spinal cord and conus are within normal limits. The nerve roots of cauda equina are unremarkable except as discussed below.L1-2: Facet arthropathy. Loss of disc height with disc bulging. Moderate to severe spinal canal narrowing with effacement of the CSF and crowding of the cauda equina. Mild bilateral foraminal narrowing. No interval changes. L2-3: Facet arthropathy, slightly progressed. Disc bulging, slightly progressed, with a new left paracentral inferiorly directed extrusion. New narrowing of the left lateral recess with perhaps mild mass effect on the transiting nerve roots. Mild right foraminal narrowing, mildly progressed. L3-4: Facet arthropathy. Ligamentum flavum thickening, right side more than left. Mild disc bulging with interval reduction in the size of a small right paracentral protrusion. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes except as above. L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal bulging disc with interval improvement in a small right paracentral protrusion. Mild spinal canal narrowing, particularly in the transverse dimension. No significant foraminal narrowing. No interval changes except as above. L5-S1: Facet arthropathy. Disc bulging and osteophytic ridging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes.
1.Endplate edema has progressed at C4-5 likely indicating some worsening of degenerative disc disease. However, the degree of multilevel mild to moderate spinal canal stenosis is unchanged. Likewise, scattered foraminal narrowing, severe at some levels, is unchanged.2.Mildly progressive facet arthropathy is seen at L2-3. In addition, there is a new small left paracentral inferiorly directed disc extrusion at this level which could be causing some displacement of the transiting nerve roots including the left L3 nerve root. Degenerative findings at additional levels are stable or in some cases slightly improved as above. L1-2 is the most significantly affected level where there is a stable moderate to severe spinal canal stenosis.