Right lumbar radiculopathy. Right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening and minimal retrolisthesis of L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position terminating at the inferior L1 level. There is focal fatty infiltration involving the filum terminale measuring approximately 1.6 x 2.7 mm in the AP and transverse dimensions and 1.8 cm in the craniocaudal dimensions, and extending from the L1-L2 to the mid L2 levels. The conus appears dorsally positioned as compared to the distal thoracic cord which is ventral.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a central and right paracentral disc extrusion with minimal craniocaudal extension with effacement of the right lateral recess and possible impingement of the descending right-sided nerve roots. There is no significant stenosis involving the central canal. There is minimal narrowing of the neural foramina. Mild facet arthropathy.L5-S1: There is a central right paracentral disc protrusion which partially effaces the right lateral recess and contacts the right S1 nerve root. No significant central canal stenosis or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. There is a cystic right adnexal lesion which is partially imaged measuring up to 2.5 x 1.6 cm and may be physiologic (ovarian follicle) in the reproductive age group.
1. Large central and right paracentral disc extrusion at the L4-L5 level which extends into the right lateral recess, where there may be impingement of the descending right L5 nerve root as well as the more posterior descending S1 nerve root. There is also a smaller right paracentral disc protrusion at L5-S1 which abuts the descending right S1 nerve root.2. Incidentally noted is a small lipoma of the filum terminale. Conus terminates at a normal position at the lower L1 level but appears dorsally displaced. This finding may be incidental but would suggest correlation for possible clinical signs of cord tethering.