Back pain, L4-L5 spondy noted on x-ray, evaluate for stenosis, abnormality. History of prior lumbar epidural abscess and laminectomy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 which is much more apparent on the radiographs from 9/8/2015. Alignment is otherwise maintained. Again seen is diffuse low T1 marrow signal which is nonspecific and can be seen with marrow reconversion related to anemia or chronic illness for example. There is particular heterogeneity of the bone marrow signal at the L5 level without edema and probably related to remote osteomyelitis. No significant bone marrow or disc space edema at any level on the current study or evidence of fluid collection to suggest residual or recurrent infection--although lack of contrast slightly limits evaluation.Evidence of prior laminectomies at L4-L5 and L5-S1. There is disc desiccation at L4-L5 and L5-S1 as before. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Evidence of prior laminectomy and grade 1 anterolisthesis. Disc bulge is minimally more prominent than prior, eccentric to the right with effacement of the right lateral recess. No significant central canal stenosis. There is advanced bilateral facet arthropathy. There is moderate right and minimal left neural foraminal narrowing.L5-S1: Evidence of prior laminectomy. Disc bulge eccentric to the right without significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. There is bilateral facet arthropathy.
1. Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels including disc bulges and facet arthropathy. There is grade 1 anterolisthesis of L4 and L5 which is much more apparent on recent upright/flexion radiographs.2. Moderate right L4-L5 neural foraminal stenosis. Additional levels as above.3. Prior laminectomies at L4-L5 and L5-S1 related to prior epidural abscess drainage. No findings to suggest recurrent infection or abscess within limitations of noncontrast study.