Reason: rule out worsening spinal stenosis History: bowel incontinence, weakness, pain There are 4 nonrib bearing lumbar vertebrae with sacralization of L5. For the purposes of this dictation, consistent with prior reports, the lowest visualized intervertebral disc space is labeled L4-S1.Vertebral body heights are within normal limits. Minimal anterolisthesis of L2 relative to L3. Minimal retrolisthesis of L3 relative to L4. Multilevel disc desiccation with disc space loss at L4-S1. Mildly increase STIR signal at L4-S1 is similar to the prior exam and likely degenerative. Mild prominence of the epidural fat is unchanged. No abnormal signal within the cord or conus which ends at L1.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum hypertrophy and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with uncovering of the disc and superimposed central extrusion extending 8 mm superiorly which is decreased and posterior extent from the prior exam. Moderate ligamentum flavum thickening and facet arthropathy, left greater than right. Moderate spinal canal stenosis is improved from the prior exam. Mild bilateral neural foraminal stenosis is unchanged.L3-L4: Diffuse disc bulge with uncovering is unchanged. Moderate ligamentum flavum thickening and facet arthropathy is unchanged. Mild spinal canal stenosis is unchanged. Moderate left and mild right neural foraminal stenosis is unchanged.L4-S1: Diffuse disc bulge, asymmetric to the right, is unchanged. Mild facet arthropathy and ligamentum flavum thickening is unchanged. No significant spinal canal stenosis. Narrowing of the right lateral recess with impingement of the descending right S1 nerve root is unchanged. Moderate bilateral neural foraminal stenosis is unchanged.Paraspinous soft tissues are within normal limits. Small left renal cyst.
1. Transitional lumbosacral anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.2. Multilevel degenerative changes with significant improvement in spinal canal stenosis at L2-L3. Additional degenerative disc disease and neural foraminal narrowing is unchanged.