Diagnosis: LumbagoClinical question: eval s/p laminotomy.Signs and Symptoms: right buttock pain radiating down right lateral thigh Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. Since the prior exam, the patient has undergone right hemilaminectomy at the L4-5 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with some loss of disc space height. The fat surrounding the nerve roots at the lateral recesses sees is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. There is mild facet hypertrophy at this level.At L4-5 the patient is status post right hemilaminectomy and partial facetectomy. There is a large right lateral recess disc extrusion present at this level which extends across the midline and is associated with obliteration of the fat at the lateral recesses bilaterally. There is compression and obliteration of the cerebral spinal fluid surrounding the nerve roots within the thecal sac at this level. To some degree this appearance of severe spinal stenosis was also present on the prior exam and has not improved. There are associated endplate reactive changes at this level which have progressed since the prior exam. There are bright on T2 and dark on T1 on the current exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. This is unchanged compared to the previous exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion present at this level which mildly displaces the right-sided exiting nerve root after it exits the neural foramen. This is unchanged compared to the previous exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is severe spinal stenosis present at L4-5 predominantly due to a large disc extrusion eccentric towards the right hemicanal. 2.The patient is status post recent right sided posterior elements surgery at the L4-5 level. Endplate reactive changes are present at this level are suspected to be related to this and likely reactive and inflammatory in nature.3.Degenerative changes are also present at other levels in the lumbar spine as detailed above.