Clinical question: Left sciatica, prior L4 -- L5 fusion in 2008 titanium plate. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of a small right renal cyst.L1 -- L2 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. No significant change since prior exam.L2 -- L3 demonstrate advanced disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophic changes and mild facet disease. No significant change since prior exam and no evidence of central spinal or neural foraminal compromise/stenosis.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy and result in moderate central spinal stenosis and bilateral neural foraminal compromise. There is interval progression of findings since prior study progression of findings from 2010.L4 -- L5 demonstrate postoperative changes of fusion of without evidence of central spinal stenosis. Mild to moderate right neural foraminal compromise without significant change since prior study.L5 -- S1 demonstrate mild disk disease and loss of disk height with shallow bulging disk (slightly more prominent on the left) and mild ligamentum flavum and moderate facet hypertrophic changes. There is no evidence of central spinal stenosis. However there is compromise of the lateral recess of the canal bilaterally (left greater than right) with slight interval worsening since prior exam in particular in the left.
1.Stable postoperative changes of posterior fusion at L4 -- L5 without evidence of spinal stenosis.2.Mild progression of degenerative changes at L3 -- L4 with moderate central spinal stenosis.3.Slight progression of degenerative disease at L5 -- S1 with compromise of the lateral recesses bilaterally.