Lumbar spinal stenosis. Bilateral thigh pain and change in bowel and bladder habits. Assess for change in stenosis. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1. Sagittal alignment is anatomic accounting for straightening. The vertebral bodies are preserved in height and their marrow signal. The lumbar discs show preserved heights and only minimal L4-L5 and L5-S1 desiccation. There are chronic soft tissue and bone changes related to previous L4-5 discectomy and partial laminectomies.The lumbar spinal canal is diffusely, congenitally narrowed. The conus medullaris tip lies at the lower L2 level, which is unchanged. Otherwise, the conus medullaris and caudal part of the spinal cord show normal signal and shape.T12-L1 and L1-L2: There is no disc herniation and only mild facet arthropathy. There is no spinal canal or foraminal stenosis.L2-L3 and L3-L4: There is mild-to-moderate facet arthropathy and ligamenta flava thickening but no disc herniation. There is mild foraminal stenosis and the mild congenital spinal canal stenosis.L4-L5: There are extensive postoperative changes from previous discectomy and partial laminectomies with thickened posterior and lateral epidural fat, which largely contrast enhances with the exception of a small area in the medial left neural foramen, which probably relates to facet osteophyte rather than disc fragment. Additionally, the thecal sac is more open than on the previous examination, which is probably related to evolution of the postoperative changes into scarring. There is marked left and moderate right facet proliferative change along with joint effusion and contrast enhancement. These are increased since the previous examination and result in moderate left and mild right neural foraminal stenosis. L5-S1: There is moderate facet arthropathy but no disc herniation. There is no spinal canal or foraminal stenosis.
1.Postoperative findings from previous L4-L5 discectomy and partial laminectomy have evolved with improved decompression of the thecal sac. However, severe left and moderate right facet arthropathy appears slightly worse and is associated with moderate left foraminal stenosis. Please correlate with left L4 radiculopathy.2.Otherwise, there is diffuse, congenital lumbar spinal canal stenosis and low lumbar facet arthropathy as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.