Reason: R leg radicular pain s/p laminectomy hx of lung cancer History: R leg radicular pain s/p laminectomy hx of lung cancerAdditional history from EMR: Status post L2-L4 bilateral laminectomy with partial medial facetectomy in 2011, 2/11/2015, presenting with new onset right thigh pain. Alignment remains anatomic. There is stable multilevel degenerative disc narrowing, moderate-severe in degree at multiple levels. There is diffuse mildly heterogeneous signal of the marrow which is nonspecific. Scattered Schmorl's nodes appear similar. There is normal cord signal and caliber distally, with the conus terminating approximately at the T12-L1 level. There is thickening and redundancy of the cauda equina nerve roots.Interval postoperative changes are seen with small left laminotomy/medial facetectomy at L3 and L4. Enhancement likely relating to granulation tissue traverses the surgical tracts without significant mass effect upon the thecal sac. There is now moderate central spinal canal stenosis at L2-L3 and L3-L4. There is continued moderate left and severe right foraminal narrowing at L3-L4.Since the prior exam, there has been interval worsening of disc disease at L3-L4 where there is now a large right paracentral disc extrusion migrating cranially x 2.3 cm. It demonstrates mild intrinsic T1 hyperintensity, enhancement, and appears slightly lower signal on T2 with respect to other disc material. The axial plane, this measures up to 1.2 x 0.8 cm and results in moderate effacement of the thecal sac spanning the L3 level. There is presumed posterior displacement of the descending right L3 and L4 nerve roots.Central spinal canal stenosis at L1-L2 appears similar although the CSF is not as well visualized which may in part be technical. There is perhaps mild interval further ligamentum flavum thickening. Previously described multilevel spondylosis is otherwise unchanged.There is again atrophy of the right psoas muscle.
1.Interval worsening of disc extrusion at L3-L4 which is right paracentral in location, now extending cranially along the entire height of the L3 vertebral body resulting in moderate central spinal canal stenosis and posterior displacement of the descending right L3 and L4 nerve roots. A portion of this may be sequestered given its differential signal from parent disc.2.Interval postoperative changes following left L3 and L4 laminotomy/medial facetectomy. Presumed enhancing granulation tissue along the surgical tracts without significant mass effect. Overall, improved thecal sac caliber at these levels.3.Otherwise, stable appearance of multilevel spondylotic changes with up to moderate left and severe right foraminal narrowing at L3-L4.