56-year-old male with increased back pain and urinary dribbling. Evaluate for lumbar stenosis. Again seen is minimal retrolisthesis of L4 on L5 and L5 on S1which is unchanged. There is also posterior spinal instrumentation involving the L3-4 vertebral levels which is new since prior MRI from 5/2/2014 but present on the CT lumbar spine from 6/19/2015. The known caudal migration of the rods are better seen on the recent previous lumbar CT from 6/19/2015 and multiple radiographs. Again seen are degenerative marrow signal changes from L3 through S1 with unchanged severe disc height loss at the L5-S1 level. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There has been interval bilateral laminectomy, discectomy and spacer placement with improvement in the disc space height and significant improvement in the spinal canal narrowing at this level. Evaluation of the neuroforamina is slightly limited given the susceptibility artifact from the hardware but there is no high-grade stenosis.L4-5: There has been a left-sided laminectomy with increased T2/STIR signal within the disc compatible with edema. There has been interval removal of the left lateral extruded disc with decompression of the left side of the spinal canal. There remains facet hypertrophy bilaterally and right-sided thickened ligamentum flavum along with the prominent asymmetric right-sided posterior epidural lipomatosis which causes some mild narrowing and displacement of the thecal sac; but overall there is no significant central spinal canal stenosis. However, prominent anterior epidural fat just inferiorly at mid L4 level causes moderate central spinal canal stenosis at this level although this was present previously and is unchanged. The degenerative changes at the L4-5 level cause at least moderate bilateral neuroforaminal stenosis greater on the left which is caused by bony osteophytes which are better seen on the recent previous lumbar CT. On postcontrast images, there is some enhancement involving the posterior aspect of the L4-5 disc and also minimally involving the ventral epidural space which is related to granulation tissue and which does not contribute to any spinal canal narrowing.L5-S1: Again seen is advanced degenerative disc disease with facet hypertrophy and ligamentum flavum thickening. Bony spurs better seen on the recent lumbar CT contributes to at least moderate bilateral neural foraminal stenosis greater on the left. Similar to the mid L4 level, there is prominent anterior epidural lipomatosis at the mid L5 level which causes moderate central spinal canal stenosis at this level but this is unchanged from the previous exam.
1.Multilevel degenerative disease of the lower lumbar spine with a posterior spinal fusion involving L3-L4 with discectomy and spacer placement at the L3-4 level and left lateral discectomy at the L4-5 level, all of which results significant improvement in the previous spinal canal stenosis at these levels. There are no findings to indicate disc reherniation.2.There is moderate spinal canal stenosis involving the mid L4 and mid L5 levels where there is prominent anterior epidural lipomatosis. There is also some asymmetric posterior epidural lipomatosis at the L4-5 level which along with right-sided ligamentum flavum thickening mildly displaces the thecal sac but there is no overall spinal canal stenosis at L4-5 disc level.3.There remains and at least moderate left greater than right L4-5 and L5-S1 neural foraminal stenosis related to degenerative changes and osteophytic components which are better seen on the lumbar CT from 6/19/2015.4.The known caudal migration of the vertical rods are better seen on the recent previous lumbar CT and lumbar radiographs.