71-year-old female with bilateral lumbar plexopathy. Assess for nerve root and lumbar plexus infiltration. There is a levoscoliosis of the lower lumbar spine with apex of curvature at L4. The lumbar spine is in normal sagittal alignment, with a slightly exaggerated lumbar lordosis. There is moderate to severe disc height loss at L4-L5 with a vacuum disc, and mild disc space narrowing at L5-S1. There is disc desiccation from L3-L4 through L5-S1. The vertebral body heights are otherwise well-maintained. Prominent degenerative endplate marrow changes are noted at L4-L5. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level.At L1-L2, there is a small left paracentral to foraminal disc protrusion without spinal canal or neural foraminal stenosis..At L2-L3, there is a minimal disc bulge with significant left far lateral prominence. There is mild left foraminal narrowing. Spinal canal and right neural foramen are patent.At L3-L4, there is a trace disc bulge with left foraminal prominence and central to right paracentral annular fissure.At L4-L5, there is a mild diffuse posterior osteophyte disc complex with minimal narrowing of the lateral recesses and central spinal canal. There is mild to moderate right and minimal left foraminal narrowing.At L5-S1, there is a mild disc bulge without significant spinal canal or neural foraminal stenosis.Linear enhancement within the lumbar spinal canal, axial post gad series 901 image 38, is similar to prior and may represent normal vascular enhancement. No definite enhancement involving the cauda equina nerve roots. There is however abnormal enhancement involving the left L4 nerve root and to a mild degree the left L5 nerve root extraforaminally. These findings are slightly less pronounced than on prior study from 8/30/2016.
1. Unchanged relatively mild scattered spondylotic disease most prominent at L4-L5 with up to mild central spinal canal stenosis and mild-moderate right foraminal narrowing at this level.2. Abnormal enhancement involving the extraforaminal left L4 and to a lesser degree left L5 nerve roots extra foraminally appear slightly less prominent than on 8/30/2016. Note current study is limited to the lumbar spine. Findings may represent an inflammatory process. Please see comment regarding cauda equina nerve roots above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.