Chronic back pain and history of degenerative disease. History of breast cancer. Evaluate for progression of degenerative disease and metastases. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Moderate degree of levoscoliosis again noted and can be better assessed with standing radiographs. Minimal anterolisthesis of L5 on S1. Bone marrow signal is benign with multiple scattered foci of T1 hyperintensity as well as a nonspecific focus of enhancement involving the L3 vertebral body, which remains unchanged and most likely benign. No evidence of metastatic disease. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal stenosis. L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is moderate right neural foraminal narrowing similar to prior. No significant left neural foraminal stenosis. L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy with no significant spinal canal stenosis. There is moderate right neural foraminal narrowing similar to prior. Mild left neural foraminal stenosis. L4-L5: Mild disc bulge, ligamentum flavum thickening, and advanced left-sided facet arthropathy. No significant spinal canal stenosis. There is severe left neural foraminal stenosis similar to prior and mild right neural foraminal narrowing. L5-S1: Mild disc bulge, ligamentum flavum thickening, and bilateral, left worse than right, facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate left neural foraminal stenosis which has progressed in the interval. No significant right neural foraminal stenosis.Paraspinous soft tissues demonstrate mild atrophy involving the paraspinous musculature but are otherwise under marked.
1. Multilevel degenerative changes in the lumbar spine including levoscoliosis with slight progression in the interval. There is no significant spinal canal stenosis at any level. There is moderate right L2-L3 and L3-L4 as well as severe L4-L5 neural foraminal stenosis. Individual levels as above.2. Multilevel facet arthropathy, relatively worse at L4-L5 and L5-S1 which may also be contributing to low back pain.3. No evidence of metastatic disease.