65 year old female; Back pain with radiation into the right leg. Clinical suspicion of radiculopathy due to discopathy.
The lower thoracic spinal canal appears normal as does the lower thoracic spinal cord, including the conus medullaris. The lower thoracic vertebral bodies and their disc spaces appear normal. In the lumbar region, the bony spinal canal is normal in caliber.
At L1/2, no significant abnormalities are seen.
At L2/3, a very minimal anterior bulge of the annulus fibrosus is noted in the midline, A more prominent bulge is noted anterolaterally on the left and this is associated with hypertrophic spurring/sydesmaphyte formation here. There is no impingement on the spinal canal and thecal sac however.
At L3/4 and L4/5, there is slight disc space narrowing and decreased signal intensity compatible with chronic degenerative change. In addition, mild to moderate, generalized bulge of the annulus fibrosus is noted posteriorly and posterolaterally, slight more prominent at L4/5. These findings are associated with narrowing of the sagittal dimension of the thecal sac due to a combination of disc bulge anteriorly and hypertrophic changes in the ligamentum flavum posteriorly as well as hypertrophic changes in the posterior longitudinal ligament all along the L3/4 region.
Additionally, at the L3-4 level, there is relative narrowing of the right foramen due to a small right lateral disc herniation (or possibly or to asymmetric disc bulging). This touches the exiting nerve root and may be causing radiculopathy.
At L4/5, relative narrowing of the left neural foramen is noted due to a combination of anatomic factors as well as some hypertrophy of the apophyseal joints. Clinical correlation is recommended for left L4 radiculopathy.
At L5/Sl, no significant abnormalities are seen.
1. Chronic degenerative disc disease at L3/4 and L4/5 with secondary hypertrophic changes as described and mild narrowing of the sagittal dimension of the thecal sac.
2. Relative right neural foraminal narrowing at L3/4 due to a small right lateral herniation (or possibly to asymmetrical disc bulging), which touches the nerve root and may be causing radicular symptoms.
3. Relative left neural foraminal narrowing at L4/5. Clinical correlation is recommended for radiculopathy at this level.