History of back pain. gait impairment. Assess for worsening of lumbar stenosis. There is multilevel degenerative spondylosis, which has progressed slightly at L2-3 and has regressed slightly at L3-4. Additional details by level as follows:L1/2: Asymmetric bulge to the left and bilateral mild facet hypertrophy with mild central canal stenosis with moderate left and mild right neural foraminal stenosis.L2/3: Interval development of a large Schmorl's node in the upper endplate of L3 and more extensive endplate degenerative bone marrow signal alterations. There is also slight interval increase in size of the disc bulge, ligamentum flavum thickening, prominent posterior epidural fat, and mild to moderate bilateral facet hypertrophy. There is moderate central, moderate bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.L3/4: There has been interval involution of the left paracentral and foraminal disc extrusion with a residual underlying disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is severe central and mild right and moderate left neural foraminal stenosis. There is also evidence of Baastrup's disease.L4/5: There is unchanged grade 1 anterolisthesis of L4 on L5, a disc bulge, ligamentum flavum thickening, moderate to severe left facet hypertrophy, and moderate right facet hypertrophy. There is mild spinal canal and mild bilateral neural foraminal stenosis. There is also evidence of Baastrup's disease.L5/S1: There is a mild disc bulge and mild left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.Miscellaneous: There is a new T10 superior endplate Schmorl's node. There are multilevel anterior disc-osteophyte complexes. There is a large gallstone. There is diffuse fatty atrophy of the paraspinal muscles.
1.Multilevel degenerative spondylosis, which has progressed slightly at L2-3 and has regressed slightly at L3-4, where there is severe and moderate spinal canal stenosis, respectively. Refer to the findings section for additional details.2.Gallstone. A dedicated ultrasound may be useful for further evaluation, if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.