Female, 70 years old, with low back pain on the right, radiating to the right hip, and decreased strength in right hip flexion. Apart from a mild scoliotic curvature at the thoracolumbar junction, spinal alignment is anatomic. Vertebral body heights are preserved. A STIR hyperintense, T1 hypointense and mildly T2 hyperintense lesion is seen within the L1 vertebral body. Minimal corresponding lucency is seen on prior CT and there is no FDG avidity on prior PET. Marrow signal characteristics are otherwise unremarkable allowing for minimal endplate degenerative signal.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Mild facet hypertrophy. Otherwise unremarkable. L2-3: Mild facet hypertrophy. Otherwise unremarkable. L3-4: Mild facet hypertrophy. Minimal disc bulging. In combination with prominent dorsal epidural fat, the thecal sac is mildly narrowed but the nerve roots do not appear to be frankly compressed. Mild bilateral foraminal narrowing.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. In combination with prominence of the dorsal epidural fat, the thecal sac is mildly narrowed but without frank nerve root compression. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Loss of disc height and disc bulging with a superimposed right subarticular and foraminal disc protrusion. The traversing right S1 nerve root is likely impinged by this process. In addition, the right neural foramen is severely narrowed with possible impingement of the exiting L5 nerve root. A mild generalized spinal canal stenosis is seen. The left neural foramen is moderately narrowed.
1.A disc herniation is evident in the right subarticular and foraminal regions at L5-S1. The traversing right S1 nerve root is likely impinged by this process. Furthermore, the disc herniation and facet hypertrophy contribute to severe narrowing of the right L5-S1 neural foramen which likely produces some impingement of the exiting L5 nerve root.2.Relatively mild degenerative findings are seen at the other lumbar vertebral levels.3.Signal abnormality within the L1 vertebral body is favored to represent a radiologically atypical benign hemangioma.