Female, 40 years old, status post right L5-S1 microdiscectomy. Assess for L5-S1 herniation. Spinal alignment is anatomic. Vertebral body height and morphology are normal. Edematous degenerative endplate signal alteration has progressed at L5-S1. In addition, several scattered foci of fatty marrow replacement are again seen similar to prior. No pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable except as discussed below. No pathologic intracanalicular enhancement is seen.Mild loss of disc height and T2 signal at L3-4 and L4-5 is stable to slightly progressed. Loss of disc height has progressed at L5-S1. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. Mild bulging disc with a central annular fissure. No significant spinal canal or neuroforaminal stenosis. No interval changes. L4-5: Moderate facet hypertrophy which may have progressed slightly. Mild bulging disc with a progressive annular fissure. No significant spinal canal or neuroforaminal stenosis. L5-S1: Postoperative findings are seen consistent with a right posterior approach for microdiscectomy. Since the prior examination, a large central/right paracentral disc protrusion has recurred, measuring at least 21 x 11 mm in the axial plane. This results in a severe spinal canal stenosis with crowding and impingement of the cauda equina nerve roots. The neural foramina themselves are not significantly narrowed. Moderate to severe facet arthropathy and ligamentum flavum thickening are unchanged.
Recurrent disc herniation at L5-S1 with significant spinal canal stenosis and nerve root impingement.