 The lumbar lordosis is preserved. Minimal anterolisthesis of L3 over L4 and L4 on L5 appear similar to prior examination. The vertebral body heights are maintained. The non-contrast bone marrow signal characteristics are within normal limits. Lumbar spinal cord signal intensity and morphology are normal throughout. The conus terminates at L1 level showing normal morphology and signal characteristics. There is congenital narrowing of the lumbar spinal canal secondary to short bilateral pedicles and posterior epidural lipomatosis. There is redundancy and thickening of the cauda equina nerve roots. There is slight loss of disk height and disk desiccation at L3-4, L4-5 and L5-S1 with vacuum disc phenomena now at L4-5 and L5-1. Additional level specific findings are as follows.T10-T11: Unremarkable. T11-T12: Unremarkable. T12-L1: Unremarkable. L1-2: Unremarkable. L2-3: There is mild central spinal stenosis on the basis of developmental spinal canal narrowing without neuroforaminal stenosis. Bilateral facet and ligamentous hypertrophic degenerative changes are seen. L3-4: There is a diffuse disc bulge with facet and ligamentous hypertrophic degenerative changes with bilateral degenerative facet joint effusions resulting in mild to moderate right and moderate left neuroforaminal stenosis. A small dorsal left facet joint synovial cyst is visualized. L4-5: There is minimal uncovering of the disc with superimposed mild disc bulge is rightward predominant. There is significant bilateral facet arthropathy and ligamentum flavum thickening, greater on the left side. This results in moderate-severe left foraminal narrowing. There is moderate central spinal canal stenosis. L5-S1: There is a diffuse disc bulge eccentric to the left with a a superimposed left paracentral disc extrusion migrating cranially indenting the left thecal sac and impinging upon the descending left S1 nerve root. There are severe left and moderate right facet/ligamentous degenerative changes resulting in moderate-severe right and moderate left neuroforaminal stenosis.
1. Developmental narrowing of the mid to distal lumbar spinal canal. 2. Multilevel degenerative changes of the lumbar spine as described above, most pronounced at L5-S1 level where there is moderate severe right and severe left foraminal narrowing, as well as at L4-L5 where there is high-grade left foraminal narrowing.