71-year-old male with history of lung cancer and lower back pain, evaluate for spinal stenosis Alignment is anatomic. There is degenerative disk disease, increased at L2-L3 and L3-L4 where there is vacuum disk phenomena. There are new endplate degenerative changes along the superior endplates of L4 and L3 and inferior endplate of L2. T1 and T2 hypointense rounded structure in the posterior aspect of L4 with mild STIR hyperintensity is unchanged and while nonspecific, may represent an atypical hemangioma. There is otherwise diffuse heterogeneous signal of the marrow. Multiple Schmorl's nodes and mild endplate depressions are unchanged. Signal within the distal cord and conus is normal, terminating at T12-L1.T10-T11: Diffuse disk bulge seen only on sagittal views is unchanged. No gross neuroforaminal or central canal narrowing.T11-T12: Central disk extrusion extending caudally 14 mm is unchanged. Mild spinal stenosis is unchanged. No neural foraminal stenosis, however there is narrowing at the left lateral recessT12-L1: Mild diffuse disk bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild to moderate spinal stenosis. Narrowing at the lateral recess ease bilaterally.L1-L2: Mild diffuse disk bulge. Ligamentum flavum thickening and facet arthropathy. Mild effacement of the ventral thecal sac, unchanged. No neural foraminal stenosis.L2-L3: Moderate diffuse disk bulge and thickening of the ligamentum flavum is unchanged. Moderate bilateral neuroforaminal narrowing, right greater than left, slightly worse on the left. Moderate to severe spinal stenosis is unchanged. Prominent epidural fat.L3-L4: Broad-based disk bulge with a right paracentral disk extrusion extending cranially 8 mm appears similar to the prior exam. Ligamentum flavum thickening and facet arthropathy. Severe spinal stenosis is unchanged. Severe right and mild left neural foramina stenosis is unchanged.L4-L5: Mild diffuse disk bulge, ligamentum flavum thickening and facet arthropathy. Moderate left and mild right neural foraminal stenosis is unchanged. Mild narrowing of the left lateral recess.L5-S1: Diffuse disk bulge and facet arthropathy without spinal or neuroforaminal stenosis.There is a right adrenal nodule consistent with adenoma, grossly unchanged. There are probable tiny right renal T2 hyperintense cysts. Atrophy of the right psoas muscle.
1.Multilevel degenerative disk disease, increased at L2-L3 and L3-L4.2.Severe central spinal canal stenosis at L2-L3 and L3-L4 is unchanged.3.Prominent disk extrusions at T11-T12 and L3-L4 are unchanged.4.Multilevel neural foraminal narrowing, slightly worse at L2-L3 where it is moderate in degree.