• The L5 vertebra is transitional, being attached to the sacrum via bilateral enlarged transverse processes and pseudarthroses-castelvi 2b.
• There is disc dehydration at L2/L3 and L4/L5. The main underlying issues is a congenitilly stenotic canal in the lower spine, with AP dimensions less than 10mm.
• At L2/l3-generalised disc bulge with lateral recess narrowing but no overt nerve compression.
• At L3/L4-similar but more pronounced lateral recess narrowing without compression, but there is ligamentum flavum hpertrophy.
• At L4/l5- There is a posterior annular fissure, with a generalised posterior bulge. This combined with ligamentum flavum hypertophy is causing moderate central canal stenosis although a tiny amount of CSF may still be present within the thecal sac, and there may well be compression of the L5 nerve roots in the lateral recesses. No foraminal nerve root compromise is identified.
• At L5/S1 bulge- There is a prominent anterolateral disc bulge with a large osteophyte. This could well be irritating the L5 level just anterior to the sacral ala.