History of discectomy in 2014, progressive numbness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. No suspicious enhancement. The conus medullaris is normal in position.Multilevel degenerative changes are seen with significant disc height loss at the L3-L4 and L4-L5 levels, interval worse at L4-L5 when compared to prior. Associated endplate marrow signal changes are also evident at these levels and slightly progressed at L4-L5. Individual levels as below:L1-L2: Small Schmorl's node as before. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge with small central disc extrusion which has progressed since prior but is not associated with spinal canal or neural foraminal stenosis.L3-L4: Tiny central disc protrusion is similar to prior and is not associated with significant spinal canal or neural foraminal stenosis. Mild facet arthropathy and ligamentum flavum thickening also again noted at this level.L4-L5: There is disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening, which appear similar to prior. There is mild left neural foraminal narrowing without clear nerve root impingement and similar to prior. No significant spinal canal or right neural foraminal narrowing.L5-S1: There is evidence of interval right-sided laminotomy at the L5-S1 level and discectomy involving the previously seen sequestered disc fragment in the right lateral recess at the right L5-S1 level. There is no evidence of reherniation at this level. There is enhancement involving the right lateral epidural space as well as surrounding the right S1 nerve root most compatible with granulation tissue. There is no significant spinal canal stenosis. Neural foramina are also patent. Mild facet arthropathy again seen.
1. Postsurgical changes of right-sided laminotomy and discectomy at the L5-S1 level. Previously seen sequestered disc fragment in the right lateral recess has been removed. No evidence of disc reherniation. Enhancement involving the right lateral epidural space and surrounding the right S1 nerve root is most compatible with scar tissue. 2. Neural foramina and spinal canal in the lumbar spine are grossly patent. Please see additional details above including slight progression of degenerative changes compared to 7/28/2014.