Degenerative Lumbar Scoliosis: This diagnosis is the most likely due to the presence of mild scoliosis centered in the upper lumbar spine with convexity towards the left, accompanied by facet arthropathy and disc bulges, which are common findings in degenerative lumbar scoliosis. The subtle disc bulge at L2/L3 and L3/L4, along with disc bulges and annular tears at L4/L5, further support this diagnosis.

Lumbar Spondylosis: The presence of facet arthropathy and disc bulges with annular tears suggests lumbar spondylosis, which is a common condition in the aging population and can coexist with degenerative scoliosis.
Lumbar Disc Disease: The disc bulges and annular tears at multiple levels (L2/L3, L3/L4, and L4/L5) indicate lumbar disc disease, which can cause pain and discomfort, although the absence of significant neural compression reduces its urgency.

Spinal Stenosis: Although the MRI does not show significant neural compression, spinal stenosis could still be a concern, especially if symptoms worsen or if there are episodes of neurogenic claudication. Missing this diagnosis could lead to delayed treatment and worsening of symptoms.
Infection or Osteomyelitis: Infections of the spine, such as osteomyelitis or discitis, can present with similar findings, including disc space narrowing and endplate changes, which are not explicitly mentioned but could be subtle. These conditions require prompt diagnosis and treatment to prevent serious complications.
Tumor: Spinal tumors, whether benign or malignant, can cause scoliosis and other degenerative changes. Although less likely, missing a tumor could have severe consequences, making it a "do not miss" diagnosis.

Ehlers-Danlos Syndrome: This genetic disorder can lead to spinal abnormalities, including scoliosis and disc problems, due to connective tissue weakness. It's a rare condition but could explain the presence of scoliosis and multiple disc issues in a younger patient or in the absence of significant degenerative changes expected for the patient's age.
Scheuermann's Disease: Although typically diagnosed in adolescents, Scheuermann's disease can lead to kyphosis and, less commonly, scoliosis. It's characterized by vertebral endplate irregularities and disc space narrowing, which are not the primary findings in this case but could be considered in the differential diagnosis of a younger patient.