Renal cell cancer, new onset terrible back pain. History of surgery in 2011. There is transitional anatomy at the lumbosacral junction with partial sacralization of the L5 vertebra which is better seen on prior CT. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 as before. There are postsurgical changes of interbody as well as posterior spinal fusion at the L3-L4 and L4-5 levels with interbody implants and posterior pedicle screws and paraspinous rods extending from the L3-L5 levels. No bone marrow infiltrating or destructive osseous lesion is appreciated to suggest metastatic disease. No obvious epidural tumor within the limits of noncontrast study. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis and significantly progressed since prior MRI from 1/10/2012. There is also mild to moderate bilateral neural foraminal stenosis which has also progressed. There is distention of the facet joints.L3-L4: Prior left-sided laminectomy. Again seen is effacement of the left lateral recess and medial aspect of the neural foramen related to posterior displacement of the interbody implant and overlying disc protrusion. This finding is grossly similar to prior and is associated with deformity of the left ventral aspect of the thecal sac. Otherwise no significant central spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: Spinal canal is surgically decompressed. This level is not well evaluated due to artifact from the hardware but the findings are grossly similar to prior. There is mild effacement of the left lateral recess and moderate to severe left foraminal stenosis related to left foraminal disc protrusion and osteophyte. There may be impingement of the left L4 nerve root. No significant central canal stenosis. Possible mild right neural foraminal stenosis but also grossly similar to prior.L5-S1: No significant spinal canal or neural foraminal stenosis. There appears to be contact of the left L5 nerve root with an osteophyte extra foraminally without clear impingement. There is facet arthropathy throughout the lumbar spine which was better seen on prior CT. Paraspinous soft tissues demonstrate no suspicious lesions. Atrophic right kidney. Left kidney surgically absent. Right iliac fossa transplant kidney partially imaged.
1. Postoperative changes of spinal fusion from L3 to L5 with development of moderate to severe spinal canal stenosis at the L2-L3 level. This finding is significantly progressed since prior MRI from 1/10/2012.2. No evidence of metastatic disease in the lumbar spine within the mild limitations of a noncontrast study. Patient refused IV contrast and was claustrophobic.3. Additional degenerative findings as detailed above including left L4-L5 neural foraminal stenosis. Effacement of the left lateral recess at the L3-L4 level related to posteriorly displaced interbody implant and overlying disc protrusion also again seen.