 The last well formed disk space is referred to as L5-S1, consistent with prior exam. There is minimal unchanged grade 1 retrolisthesis of L4 on L5. The osseous marrow signal is benign with scattered foci of hemangioma versus focal fat deposition. The vertebral body heights are intact. There is unchanged desiccation of the L3-4, L4-5 and L5-S1 disks with mild loss of disk height at L3-4, and L4-5 and moderate loss of disk height at L5-S1. The conus terminates at L1 and shows normal signal and caliber.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation and bilateral facet arthropathy with no spinal stenosis.L2-3: Minimal disk bulge, ligamentum flavum thickening, and bilateral facet arthropathy without significant spinal canal or neural foraminal stenosis.L3-4: Mild diffuse disk bulge, ligamentum flavum thickening, bilateral facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L4-5: Previously seen right paracentral protrusion has improved with decreased but persistent mass effect upon the right traversing L5 nerve root in the right subarticular zone. There is a dorsal annular fissure. Minimal spinal canal stenosis, improved from prior examination. No significant neural foraminal stenosis.L5-S1: Diffuse disk bulge, asymmetric to the left, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant spinal canal or left neural foraminal stenosis. There is mild right neural foramina narrowing. The disk material encroaches upon the bilateral descending S1 nerve roots without significant stenosis involving the subarticular zone.
Compared to 8/13/2012, there is slight decrease in size of L4-L5 paracentral protrusion. There may be however some residual mass effect upon the traversing right L5 nerve root in the subarticular zone. There is also mild right L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foramina stenosis is seen in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.