Low back pain, history of lumbar fusion, radicular pain. Left lower extremity atrophy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis.. Bone marrow signal is benign including T1 hyperintense lesions at the T11 and L2 vertebral bodies compatible with hemangiomas. The conus medullaris is normal in position. There are postsurgical changes of prior laminectomy at the L4-L5 and L5-S1 levels.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is some loss of disk height and left paracentral disk protrusion with partial effacement of the left lateral recess which may be effecting the traversing L5 nerve root. There are prominent degenerative endplate marrow signal changes. There is mild right and moderate left neural foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.L5-S1: There is severe loss of disk height and prominent degenerative endplate marrow signal changes. There is diffuse disk bulge which involves the bilateral lateral recesses and foramina. There is an osteophyte component. There is severe left and moderate to severe right foraminal stenosis. Central spinal canal is patent with laminectomy at this level noted. Mild facet arthropathy.Paraspinous soft tissues are postsurgical changes but are within normal limits. Bilateral renal cysts incidentally noted.
1. Advanced degenerative changes at the L4-L5 and L5-S1 levels with evidence of prior laminectomies at these levels. There is no significant spinal canal stenosis at any level. 2. There is moderate left L4-L5 and severe left L5-S1 neural foraminal stenosis which may be impinging on the left L4 and L5 nerve roots. There is also effacement of the lateral recesses at these levels, left greater than right, where there may be impingement of the traversing L5 and S1 nerve roots.