Loss of patellar reflex on left leg and weakness and pain of left lower extremity. Evaluate for compression of L4. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Severe loss of disc space at the L3-L4 level as well as grade 1 retrolisthesis which appears slightly worse since 6/23/2014. Associated endplate marrow edema however has slightly decreased. Previously seen disc extrusion at this level is no longer present. Conus is in normal position. No suspicious osseous lesions. Multilevel degenerative changes are 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: Severe loss of disc height and mild retrolisthesis which has slightly progressed. There is interval resolution of previously seen disc extrusion. There is mild narrowing of the left lateral aspect of the spinal canal related to facet arthropathy, otherwise no significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing and mild left neural foraminal narrowing. Previously seen right lateral recess effacement has resolved related to surgical removal of disc material.L4-L5: There is moderate to severe spinal canal stenosis at this level which appears progressed, and related to combination of facet arthropathy, ligamentum flavum thickening, and mild disc bulge. There is also lobulated soft tissue measuring approximately 6 mm in the AP dimension along the dorsal aspect of the spinal canal which may be related to postoperative scar tissue, chronic blood products, or possibly synovial cyst. There is moderate narrowing of the left neural foramen and mild narrowing of the right neural foramen which appear worse. There is effacement of the left lateral recess partially related to disc material. There is mild interval in distention of the bilateral facetsL5-S1: Disc height loss and mild bulge. Mild facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.
Multilevel degenerative changes in the lumbar spine are again seen. Compared to 6/4/2014, interval removal of disc extrusion at the right L3-L4 level is seen with marked improvement in the previously seen spinal canal stenosis at this level. There is slight interval worsening of disc height loss and retrolisthesis at this level.At the L4-L5 level, there is moderate to severe spinal canal stenosis which is worse in the interval as well as worsened neural foraminal stenosis, particularly on the left, where there may be impingement of the left L4 nerve root. There may also be impingement of the left L5 nerve root in the left lateral recess. Please see additional details above.