Diagnosis: Other idiopathic scoliosis, site unspecifiedClinical question: assess stenosisSigns and Symptoms: degen scoli, LBP 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 a rotatory dextrocurvature to the lumbar spine. Incidental note is made of fatty filum.Postcontrast imaging demonstrates infiltrative-type enhancement in the right neural foramen and paraspinous tissues at L5-S1 and the left paraspinous tissues and neural foramen at L2-3 and L3-4.At L5-S1 there is loss of disc space height, as well as a right far lateral broad-based disc protrusion with extension into the right neural foramen and behind the adjacent endplates. There is effacement of the fat surrounding the exiting nerve roots within the right neural foramen at this level. There is some displacement of the nerve roots at the right lateral recess at this level. Compared to the previous exam this has not changed substantiallyAt L4-5 there is loss of disc space height and disc desiccation, endplate reactive changes and a diffuse disc bulge associated with Schmorl's nodes. The Schmorl's nodes appear to be new since prior exam. There is redemonstration of small right lateral translation of L4 on L5.. There is effacement of the fat at the right lateral recess at this level with encroachment of the nerve roots at the right lateral recess. There is also some effacement of fat at the left lateral recess at this level with encroachment of the nerve roots at the left lateral recess. The fat surrounding the right-sided exiting nerve root within the left neural foramen at this level is partially effacedAt L3-4 there is a diffuse disc bulge present associated with the area of the neural foramina worse on the left side the right. The fat surrounding the left-sided exiting nerve root within the left neural foramen at this level is partially effaced. Extruded disc material behind the L4 vertebral body at this level has regressed in volume. There is less encroachment of the left lateral recess on the current exam when compared to the prior. There is right lateral translation of L3 on L4. There are some new Schmorl's nodes present at this level. The endplate reactive changes appear to have mildly progressed. There are endplate reactive changes on the left side at this level with T2 signal hyperintensity and contrast enhancement.At L2-3 there is a new left far lateral disc protrusion and encroachment of the left-sided exiting nerve roots within the neural foramen and encroachment of the nerve roots at the left lateral recess. There are endplate reactive changes on the left side at this level with T2 signal hyperintensity and contrast enhancement.At L1-2 there is loss of disc space height, disc desiccation and disc bulge.
1.There is redemonstration of multilevel degenerative changes in the lumbar spine with a rotatory dextroscoliotic curvature to the lumbar and right lateral translation of L3 on 4 and L4 and L5. In general degenerative changes in the lower lumbar spine continued to progress compared to the prior exam.2.Since the prior exam a disc extrusion at L3-4 has regressed. It is associated with inflammatory changes in the left neural foramen at this level along the left-sided exiting nerve roots.3.Since the prior exam a left far lateral disc protrusion at L2-3 has developed. It is associated with encroachment of the nerve roots within the left neural foramen at this level. It is associated with inflammatory type changes along the left-sided.4.There is encroachment of nerve roots at the lateral recess bilaterally at L4-5 due to degenerative changes. The effacement at the right lateral recess due to disc material has mildly increased on the current exam when compared to the prior exam.5.Encroachment of the right-sided exiting nerve roots at L5-S1 stable since the prior exam. This is now associated with inflammatory change along the right-sided exiting nerve roots.6.Encroachment of the nerve roots at the right lateral recess and right neural foramen at L4-5 is stable compared to the prior exam.