Bilateral lower extremity weakness, left more than right. Back pain and history of L4-L5 disc herniation. There is also currently suspicion of ALS. At L4-L5, a disc bulge with a right paracentral protrusion mildly narrows the right subarticular recess. The disc bulge and moderate facet arthropathy also result in mild-to-moderate right and mild left neural foraminal stenosis. The right facet arthropathy is associated with minimal fluid and synovial contrast enhancement. There is no significant spinal canal or foraminal stenosis at T12-L1, L1-L2, L2-L3, L3-L4, and L5-S1. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is no abnormal spinal cord or nerve root contrast enhancement.
Mild L4-L5 degenerative spondylosis is associated with right paracentral disc protrusion and mild-to-moderate right and mild left neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.