Male, 66 years old, right leg pain, history of left diskectomy. A mild scoliotic curvature is seen but otherwise alignment is anatomic. Vertebral body height is preserved. Endplate edema is seen at L5-S1 similar to the prior exam. Edema is also evident in the L5 spinous process and the soft tissues surrounding the left-sided posterior elements. Bilateral pars interarticularis defects are suspected at L5-S1 and these were present previously.The visualized spinal cord and conus demonstrate normal signal intensity and morphology. Details of the cauda equina will be discussed below.Generalized loss of disk height is seen through the lumbar spine. In addition, there is prominence of the dorsal epidural fat from T12-L1 through L3-4 which contributes to areas of canal narrowing as discussed below.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. No changes. L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with perhaps a small left paracentral protrusion. Along with epidural fat, findings contribute to a moderate spinal canal stenosis, perhaps mildly progressed. There is mild left foraminal narrowing, unchanged. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk. Along with epidural fat, findings contribute to a moderate to severe spinal canal stenosis and crowding of the cauda equina, perhaps slightly progressed relative to the prior exam. Mild bilateral neuroforaminal narrowing, unchanged.L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. A subcentimeter left ligamentum flavum cyst has decreased in size. Bulging disk. Along with epidural fat, findings contribute to a moderate spinal canal stenosis, perhaps slightly progressed. Moderate bilateral foraminal narrowing, unchanged. L4-5: Severe facet hypertrophy. Ligamentum flavum thickening. Bulging disk. Mild progression of epidural fat. Mild spinal canal stenosis, slightly progressed. Severe right and mild left foraminal narrowing, unchanged. L5-S1: Left-sided laminectomy which is new from the prior exam. Facet hypertrophy. Bulging disk asymmetric to the left. Epidural fat is prominent in the right aspect of the canal and absent on the left aspect of the canal. The thecal sac is deviated towards the left and may be mildly narrowed. Severe bilateral foraminal narrowing is unchanged.
1. Evidence of interval left-sided laminectomy at L5-S1 is seen. The epidural fat is prominent on the right of the spinal canal at this level resulting in slight leftward displacement of the thecal sac and perhaps mild thecal sac narrowing. Severe bilateral foraminal narrowing is unchanged.2. Chronic bilateral pars interarticularis fractures at L5. Significant endplate edema at L5-S1 is seen with edema also seen in the L5 spinous process and the surrounding soft tissues.3. Multilevel degenerative findings as above with a mild degree of interval progression. For example, there are stenoses at L1-2 through L4-5 which seem slightly worse than on the prior examination which may represent slight progression of either the bulging disks or epidural fat.