 Vertebral body heights in the lumbar spine are normal. Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at an appropriate level. Again seen are endplate irregularities involving the endplates of all of the vertebral bodies from the T11 to the S1 levels, most compatible with multiple Schmorl's nodes. Compared to 11/24/2015, there is increase in STIR hyperintensity and enhancement involving the inferior endplate of the L5 vertebral body likely on a degenerative basis and probably reflecting developing Schmorl's node. Increased enhancement is also noted in the right paravertebral region. Also seen is slight increase in endplate irregularity involving the superior endplate of the L1 vertebral body with slight increase in previous seen STIR hyperintensity and enhancement at this level. Remainder of the foci of STIR hyperintensity and enhancement involving the endplates are not appreciably changed.Again seen is a subtle enhancing lesion in the posterior thecal sac at the L1-L2 level, sagittal post gad image 9/17, measuring 8 x 5 mm, which may represent a small nerve sheath tumor and unchanged since 11/11/2013. No evidence of metastatic disease within the lumbar spine.There are multilevel degenerative changes, as described below:T12/L1: No significant central canal stenosis or neuroforaminal compromise.L1/2:No significant disk disease, spinal canal or neural foramina stenosis. L2/3: Disc bulge with small left paracentral disc protrusion is again seen which partially effaces the left lateral recess slightly less prominent than prior studies. Minimal left neural foraminal narrowing. Right neural foramen is patent. Minimal central spinal canal stenosis related to ligamentum flavum thickening, epidural fat, and facet arthropathy.L3/4: Disc bulge, facet hypertrophy and ligamentum flavum hypertrophy without significant spinal canal stenosis or neuroforaminal narrowing.L4/5: Disc bulge, facet hypertrophy and ligamentum flavum hypertrophy resulting in partial effacement of the right lateral recess, mild central canal stenosis, and mild to moderate right neuroforaminal narrowing. Mild left neural foraminal narrowing. L5/S1: Disc bulge and facet hypertrophy resulting in moderate right neural foraminal stenosis. The right-sided stenosis is similar to 11/24/2015 but worse than 11/14/2014. There is mild left neural foraminal narrowing. No significant spinal canal narrowing.
1. No evidence of metastatic disease in the lumbar spine.2. Multiple Schmorl's nodes throughout the lumbar spine again seen. Compared to 11/24/2015, there is worsened signal abnormality involving the inferior L5 endplate likely reflecting increased edema associated with developing Schmorl's node. More subtle worsening of endplate signal abnormality is seen associated with the Schmorl's node at the the superior L1 endplate.3. Subtle enhancing lesion in the thecal sac at the L1-L2 level, sagittal post gad image 9/17, measuring 8 x 5 mm is not significantly changed since 11/11/2013 and may represent an intradural extramedullary lesion such as a small nerve sheath tumor or perhaps meningioma. 4. Mild to moderate degenerative changes of the lumbar spine as detailed above. There is mild to moderate right L4-L5 and moderate right L5-S1 neural foraminal stenosis. Mild spinal canal stenosis at L4-L5 is also present.