Clinical question: Evaluate etiology of recurrence lumbar pain and RLE weakness. Signs and symptoms: As above. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild degenerative changes in unremarkable otherwise and stable since prior study.L1 -- L2 demonstrate minimal degenerative changes without spinal stenosis or neural foramina compromise and stable since prior exam.L2 -- L3 similar to prior exam demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disease and loss of disk height, mild to moderate bilateral ligamentum flavum and facet hypertrophic changes without the appreciable change since prior exam. No spinal stenosis or neural foraminal compromise. There is revisualization of a stable tiny synovial cyst projecting posterior to the left articulating facet at this level.L4 -- L5 demonstrate advanced degenerative disk disease and moderate loss of disk height and with associated adjacent Modic signal changes of the endplate without convincing evidence of interval change. There is mild hypertrophic changes of posterior elements present without significant change. There is expected postoperative changes of a right-sided laminectomy similar to prior study. There is however significant decreased size of a large previously noted disk protrusion in midline and to the right since prior exam. Remaining broad based shallow disk protrusion at this level results in subtle indentation of the thecal sac without central spinal stenosis. There is however moderate to severe bilateral neural foraminal compromise (right greater than left) secondary to degenerative changes at this level. Mild right lateral recess compromise at this level is also noted without change since prior exam.L5 -- S1 demonstrate mild degenerative changes without spinal stenosis or neuroforaminal compromise.
1.Degenerative changes at L4 -- L5 without significant change since prior exam and with persistent bilateral neural foraminal compromise as detailed. There is interval significant decreased size of a disk protrusion at this level and without evidence of central spinal stenosis.2.Unremarkable lumbar MRI exam otherwise with the exception of stble mild degenerative changes without spinal stenosis or neural foraminal compromise.