Diagnosis: Sciatica, right sideClinical question: evaluate for nerve impingementSigns and Symptoms: Rt side sciatica 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.At L5-S1 there is loss of disc space height, diffuse disc bulge, disc desiccation and bilateral facet hypertrophy associated with effacement of the fat at the lateral recess is somewhat worse on the left versus the right side and a moderate degree of spinal stenosis. The exiting nerve roots within the left neural foramina are mildly encroached. The right-sided exiting nerve roots within the neural foramina are surrounded by fat. These findings have progressed since the 2007 exam.At L4-5 there is mild anterior subluxation of L4 on L5 associated with bilateral facet and ligamentum flavum hypertrophy as well as a diffuse disc bulge. There is complete effacement of the fat at the lateral recesses sees and near obliteration of the thecal sac indicating a severe degree of spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at this level with partial effacement of the fat surrounding the exiting nerve roots. There is loss of disc space height and disc desiccation at this level. These findings have progressed since the 2007 exam.At L3-4 there is bilateral facet hypertrophy associated with a disc bulge. There is loss of disc space height and disc desiccation at this level. There is mild encroachment of the right-sided exiting nerve roots within the neural foramen at this level. Overall there is a mild degree of spinal stenosis present at this level.At L2-3 there is a diffuse disc bulge present associated with disc desiccation and mild facet and ligamentum flavum hypertrophy. There is narrowing of the thecal sac. There is mild narrowing of the neural foramina bilaterally at this level. Overall there is mild spinal stenosis at this level.At L1-2 there is loss of disc space height, disc desiccation, diffuse disc bulge and bilateral facet ligamentum flavum hypertrophy with partial effacement of the fat at the lateral recess on the right side. There is mild narrowing of the neural foramina at this level. Overall there is a mild to moderate degree of spinal stenosis at this level. There are associated endplate reactive changes at this level which are bright on T1. These findings have mildly progressed since the 2007 exam.Some degenerative changes are also observed in the lower thoracic spine.There is a cystic type lesion present in the right kidney which measures 25 x 15 mm in axial dimensions and was also present on the 2007 exam but was smaller at that time.
There are multilevel degenerative changes present in the lumbar spine with severe spinal stenosis at L4-L5 due to degenerative changes and subluxation as well as a moderate degree of spinal stenosis at L4-5. There is moderate spinal stenosis at L5-S1 predominantly affecting the nerve roots at the left lateral recess. The spinal stenosis at L4-5 and L5-S1 have progressed since the prior exam. There is mild to moderate spinal stenosis at L1-2 which is minimally progressed since the prior exam. There are lesser degrees of spinal stenosis present at L2-3 and L3-4 as detailed above.