Female, 62 years old, status post L4-5 fusion for stenosis with metal plate and 2010, with worsening of lower extremity tingling and numbness. Evidence of posterior instrument fusion is seen from L3 through L5 with bilateral pedicle screws affixed to posterior stabilization rods. Bilateral laminectomy has been performed at L3-4 and L4-5 with placement of interbody fusion devices within the L3-4 and L4-5 disc spaces. Small fluid locules are evident within the laminectomy bed, likely chronic and related to surgery.A focal kyphotic angulation of the lumbar spine is seen centered at L2-3. Otherwise, sagittal alignment is unremarkable. Vertebral body heights are preserved. No areas pathologic marrow replacement or marrow edema are observed.The visualized distal spinal cord and conus are within normal limits. L1-2: Mild facet arthropathy. Otherwise unremarkable. L2-3: Marked facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal stenosis with crowding of the nerve roots and near complete effacement of CSF. Severe bilateral foraminal narrowing. L3-4: Postoperative findings. No significant spinal canal or foraminal stenosis. L4-5: Postoperative findings. No significant spinal canal or foraminal stenosis. L5-S1: Advanced facet arthropathy, left more than right. Ligamentum flavum thickening. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing.
Expected findings are seen status post posterior instrumented fusion from L3 through L5. The spinal canal is well decompressed through this region and the neural foramina are not significantly compromised.At L2-3, however, posterior element hypertrophy and disc bulging contribute to produce a moderate to severe spinal canal stenosis with crowding of the nerve roots and significant neural foraminal narrowing as well. Note is also made of mild to moderate foraminal narrowing at L5-S1 due largely to facet arthropathy.