Absent reflexes in the bilateral patellae and ankles. Pain in right leg. Right leg gives out. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is diffusely heterogeneous. No discrete marrow infiltrating or destructive lesion is evident. Scattered foci of T1 hyperintensity are consistent with foci of fat or small hemangiomas. There are small foci of T2/STIR hyperintensity in the bone marrow without clear T1 shortening such as the involving the L1 vertebral body in its lateral aspects measuring up to 15 x 12 mm as well as a smaller one involving the left L4 vertebral body; these lesions may possibly represent atypical hemangioma but are nonspecific and would suggest comparison with prior MRI if available. Expansile lesions involving the spinal canal at the S2 level are consistent with perineural cysts and abut the S1 and S2 nerve roots. There is an 11 mm lesion posterior to the facet joint at the left L5 level likely representing a synovial cyst. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge without significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Mild disc bulge and facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Mild disc bulge and mild bilateral facet arthropathy no significant spinal canal or left neural foraminal stenosis. Mild right neural foraminal narrowing.L4-L5: There is a disc bulge with a small left foraminal protrusion as well as facet arthropathy bilaterally. There is partial effacement of the lateral recesses. There is no significant central spinal canal or right neural foraminal stenosis. There is moderate left foraminal stenosis and possible impingement of the left exiting L4 nerve root.L5-S1: Small left posterior annular fissure. Otherwise no significant disc disease or spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.
1. Overall mild multilevel degenerative changes in the lumbar spine. There is no significant central spinal canal stenosis at any level. There is mild right L3-L4 and more significant left L4-L5 neural foraminal stenosis where there may be impingement of the exiting left L4 nerve root. Additional levels as above.2. Prominent perineural cysts at the S2 level which are a relatively common incidental finding. These lesions however appear to have mild local mass effect on the S1 and S2 nerve roots which is of uncertain clinical significance.3. Small nonspecific lesions involving the L1 and L4 vertebral bodies as above. These may represent benign entity such as atypical hemangioma but would suggest comparison with prior MRI if available or follow-up to ensure stability. No discrete marrow infiltrating or destructive lesion is evident. 