Low back and leg pain. History of lumbar fusion greater than 2 years ago. Assess for stenosis and and degeneration above fusion. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is maintained. Postoperative changes of L4-L5 fusion again seen with interbody graft, pedicle screws, and paraspinous rods better assessed on same-day CT. Bone marrow signal is benign with with mild nonspecific heterogeneity. The conus medullaris is normal in position.There are multilevel degenerative changes with a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012. L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and height loss with a left-sided disc protrusion which is new since prior. There is also ligamentum flavum thickening and facet arthropathy. There is effacement of the left lateral recess as well as mild to moderate central canal stenosis. There is minimal narrowing of the neural foramen on the left. No right neural foraminal stenosis.L4-L5: Postoperative changes of fusion as above. There is mild right-sided neural foraminal narrowing related to endplate osteophyte. There is no spinal canal or left neural foraminal narrowing.L5-S1: Disc desiccation with mild disc height loss and small central disc protrusion with calcification. Disc contacts the S1 nerve root without clear impingement. No significant central canal stenosis. No significant neural foraminal stenosis. Paraspinous soft tissues are within normal limits.
Postoperative changes of L4-L5 fusion with hardware better seen on CT from same day. There is a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012, and results in effacement of the left lateral recess. There is also mild to moderate central canal stenosis at this level. No high-grade neural foraminal stenosis is evident at any level. Please see above for additional details.