65-year-old female with lumbar degenerative disc disease, spinal stenosis and facet arthropathy. With low back pain radiating down the bilateral lower extremities. There are apparently four non-rib-bearing lumbar vertebral bodies; this is a different numbering convention compared to what was used on the prior MRI. There are degenerative changes in the lower lumbar spine, as well as 10 mm of L3 upon L4 anterolisthesis and convex right lumbar scoliosis. In particular, at L3-L4, there is disc desiccation, loss of intervertebral disc space, severe disc bulge, moderate to severe facet arthropathy with effusions, and ligamentum flavum hypertrophy causing severe spinal canal stenosis and severe left and mild to moderate right neural foraminal stenosis. This has progressed when compared to the prior exam and there appears to be a new disc extrusion or sequestration that measures up to 10 mm posterior to the left aspect of the L3 vertebra. At L2-L3, there is a mild disc bulge, ligamentum flavum hypertrophy and mild facet arthropathy without significant spinal canal or neural foramen narrowing, and at L4-S1, there is disc desiccation, mild disc bulge, and mild to moderate facet arthropathy, with mild spinal canal and bilateral neural foraminal stenosis. There is associated degenerative bone marrow signal alteration and endplate irregularities at L3-4 and L4-S1. There is no significant spinal canal or neural foramen narrowing at T12-L1 and L1-2. The vertebral body heights are within normal limits. The conus medullaris is normal in position, but there is extensive buckling of the nerve roots at the L3 level. The paraspinous soft tissues are within normal limits, aside from dependent edema in the posterior subcutaneous tissues. There is unchanged thickening of the left adrenal gland.
1. Apparently four non-rib-bearing lumbar vertebral bodies; this is a different numbering convention compared to what was used on the prior MRI. Degenerative spondylosis of the lower lumbar spine, which is most pronounced at the L3-L4 level with severe spinal canal stenosis with compression of the cauda equina nerve roots and severe left and mild to moderate right neural foraminal stenosis, as well as an apparent disc extrusion or sequestration that measures up to 10 mm posterior to the left aspect of the L3 vertebra. The degenerative spondylosis has progressed since 2013.2. Convex right lumbar scoliosis and 10 mm of L3 upon L4 anterolisthesis. 3. Unchanged thickening of the left adrenal gland, which is nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.