 The last well-formed disk space is referred to as L5-S1. There is an 18 x 16 x 20 mm sclerotic lesion in the central, posterior and superior aspect of L5 vertebral body which does not enhance; it has been stable from 3/2014 and on prior nuclear medicine bone scan shows no significant uptake. There are no other discrete osseous lesions or suspicious enhancement in the lumbar spine.There is normal alignment with preserved vertebral body heights and osseous marrow signal intensity elsewhere. There is disk dessication and loss of disk height at multiple levels. There is increased intrinsic T1 signal intensity in the L3-4 through L5-S1 disks without enhancement, more conspicuous caudally; on the prior CT, there was noted to be vacuum disk phenomenon at these levels. This is a nonspecific finding and could be due to degenerative disks, metabolic or other etiologies. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: Mild disk bulge and moderate facet arthropathy and prominent posterior epidural fat with no significant spinal canal stenosis, and mild left neural foraminal stenosis.L2-3: Moderate disk bulge and facet arthropathy with prominent posterior epidural fat and ligamentous thickening. Mild spinal canal stenosis. Mild right and moderate left neural foraminal stenosis.L3-4: Diffuse disk bulge and moderate facet arthropathy, prominent posterior epidural fat and ligamenta flava thickening causing moderate spinal canal and bilateral neural foraminal stenosis.L4-5: Diffuse disk bulge asymmetric to the right, advanced facet arthropathy, ligamenta flava thickening and prominent posterior epidural fat. No spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.L5-S1: Diffuse disk bulge and moderate facet arthropathy with no spinal canal stenosis and moderate bilateral neural foraminal stenosis with impingement of the right exiting L5 nerve root from disk material.
1.Stable L5 superior/posterior endplate sclerotic nonenhancing lesion likely representing enostosis. Possibility of sclerotic metastasis is felt to be unlikely, especially given stability, absence of enhancement and lack of uptake on prior nuclear medicine bone scan from last year.2.Multilevel lumbar spondylosis worst at L3-4 where there is moderate spinal canal stenosis. Variable neural foraminal stenoses as described above, worst at L4-5 and L5-S1 with impingement of the right exiting L5 nerve root from disk material. Please see details above.