Female, 58 years old, with low back and leg pain. History of lumbar fusion. Artifact related to an interspinous fusion device is evident at L4-5 and L5-S1.Trace retrolisthesis of L5 relative to S1 is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Fatty endplate degenerative changes are seen at L5-S1. Otherwise, marrow signal characteristics are unremarkable.The visualized distal spinal cord, conus and cauda equina are within normal limits except as discussed below. No epidural abnormalities are suspected. The spinal canal is congenitally slender and this becomes particularly exaggerated at lower lumbar levels.T12-L1: Progressive right facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged.L1-2: Mild facet arthropathy, unchanged . No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet arthropathy, unchanged. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy, unchanged minimal disc bulging. Prominence of the dorsal epidural fat. Mild narrowing of the thecal sac, unchanged. No significant foraminal narrowing. L4-5: Bulky facet hypertrophy and postoperative changes of the posterior elements. Disc bulging with a superimposed right paracentral/foraminal protrusion which is new. Severe spinal canal stenosis with crowding of the cauda equina nerve roots which has progressed. Moderate right foraminal narrowing, unchanged. L5-S1: Moderate facet arthropathy and postsurgical changes of the posterior elements. Bulging disc. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing, unchanged.
1.Postoperative findings compatible with interspinous fusion are seen at L4-5 and L5-S1.2.Since the prior examination, bulky facet hypertrophy has progressed at L4-5 and there is a new right paracentral/foraminal disc protrusion. These findings contribute to worsening of the severe spinal canal stenosis at this level.3.Facet arthropathy on the right at T12-L1 has progressed. Significant foraminal narrowing at L5-S1 is unchanged.