Reason: eval for spinal canal stenosis History: bilateral LE weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.There is mild superior compression of the T11 vertebral body which is not present on the prior exam and is associated with high signal on T1 suggesting that this is chronic.At L5-S1 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. There is no substantial change compare the prior exam.At L4-5 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. Since the prior exam the patient has developed lobe with more endplate reaction.At L3-4 there is no significant compromise to spinal canal or neural foramina. Since the prior exam the patient has developed a left paramedian disk protrusion which mildly impresses on the thecal sac at the left lateral recess and minimally encroaches on the nerve roots of the left lateral recess.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present this level associate with some ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is T2 signal hyperintensity within the disk space at this level associated with Schmorl's nodes. The endplates are preserved and there is no perivertebral soft tissue swelling appreciated. Since the prior exam the only difference is appreciated is the T2 signal hyperintensity. There is subtle adjacent endplate contrast enhancement following gadolinium administration but no disk enhancement. Since the prior exam the patient's right renal pelvis and ureter have an enlarged. The kidneys are atrophic. There is a large cyst associated with the left kidney which was not present on the prior exam. The cyst measures 32 x 40 mm axial dimensions. There is partial visualization of a kidney in the right pelvis.
1.Degenerative changes are present in the lumbar spine which have mildly progressed since the prior exam. At L3-4 there is a new left lateral recess and paramedian disk protrusion which mildly encroaches on the nerve roots at the left lateral recess at this level. 2.T2 signal hyperintensity within the L1-2 disk space is suspected to be degenerative in nature. There are no specific stigmata for diskitis appreciated. Please correlate with patient's clinical symptoms. A CT scan demonstrating vacuum disk phenomenon similar to the CT of the abdomen from 2011 may help confirm likely DJD.3.There is a mild (<10%) chronic superior endplate compression of the T11 vertebral body which is new since 2007.4.Dr Laura Carlson pager 9903 was paged to discuss the above findings and the findings were discussed.