Male, 75 years old, with right foot drop and previous right L5-S1 microdiscectomy. Assess for stenosis. Sagittal alignment is anatomic. Vertebral body height and morphology are unremarkable. No worrisome marrow signal replacement or marrow edema is seen.The visualized spinal cord and conus are unremarkable. The cauda equina as discussed below.T12-L1: Right paracentral annular fissure. No significant disc herniation, spinal canal stenosis or neuroforaminal narrowing. No interval changes.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc, stable to slightly improved. No significant spinal canal stenosis or neuroforaminal narrowing. No other interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a new right paracentral protrusion. Findings contribute to produce a new moderate spinal canal stenosis with crowding of the cauda equina nerve roots. No significant foraminal narrowing. L3-4: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc with central protrusion, progressed from prior. Findings contribute to produce a worsened moderate to severe spinal canal stenosis with crowding of the cauda equina. No significant foraminal narrowing. L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with central and left far lateral annular fissuring. A central disc protrusion seen on the prior examination has improved. A moderate spinal canal stenosis is seen with minimal crowding of the cauda equina, improved from prior. Mild bilateral foraminal narrowing, unchanged. L5-S1: Moderate facet hypertrophy. Minimal bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. Linear T1 hyperintensity along the endplates may reflect sequelae of prior microdiscectomy, though no other definite surgical findings are seen at this level.
1.New right paracentral disc protrusion at L2-3, along with posterior element hypertrophy, contribute to interval worsening of a moderate spinal canal stenosis.2.Progressive disc bulge and central disc protrusion at L3-4, along with posterior element hypertrophy, contribute to interval worsening of a moderate to severe spinal canal stenosis.3.Interval resolution of a central disc protrusion seen previously at L4-5 with improvement of moderate spinal canal stenosis.