Low back pain Five lumbar type vertebral bodies are presumed to be present. There is approximately 25% loss of height involving the L5, approximately 20% loss of height involving the L2 vertebral body, and minimal loss of height involving the L1 and L3 vertebral bodies. No edema within the vertebral bodies and no significant change since 10/19/2012. Small Schmorl nodes at multiple levels again seen. There is grade 1 retrolisthesis of L2 on L3 and slightly greater at L3 on L4. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1. There is slight worsening of the retrolisthesis of L3 on L4 compared to prior. Alignment is otherwise unchanged since 10/19/2012. Bone marrow signal is benign. The conus medullaris is normal in position at the mid L2 level. Again seen are postsurgical changes of laminectomy at L4-L5, medial facetectomy, and posterior interspinous fixation.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal retrolisthesis and mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: There is grade 1 retrolisthesis (which is slightly worse since MRI from 2012), disk uncovering, and mild disk bulge. There is mild bilateral facet arthropathy. There is prominence of the epidural fat, similar to prior with mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis relatively worse since 2012. There is central clumping of the cauda equina nerve roots. L4-L5: Spinal canal is surgically decompressed with mild narrowing of the spinal canal related to calcifications along the lamina, better seen on the CT. Anterolisthesis is similar to prior. There is bilateral facet arthropathy. There is mild to moderate right and mild left neural foramina stenosis. There is central clumping of the cauda equina nerve roots. L5-S1: There is grade 1 anterolisthesis with disc uncovering and mild bulge which is eccentric to the right involving the right neural foramen. No spinal canal stenosis. There is moderate bilateral neural foraminal stenosis, worse on the left. Paraspinous soft tissues are unremarkable aside from postsurgical changes and mild paraspinous muscle atrophy.
1. Compared to MRI 10/19/2012, there are post surgical changes of interval spinal canal decompression at L4-5 and interspinous fixation.2. Central clumping of the cauda equina nerve roots from L3-4 to L4-5 suggestive of arachnoiditis.3. Mild spinal canal narrowing at L3-L4 and L4-5.4. Moderate bilateral L5-S1 neural foraminal stenosis and to a lesser degree at L3-4 and L4-5 as detailed above.5. Spondylolisthesis from L2-3 to L5-S1 largely similar to 2012; mild L3-4 retrolisthesis is slightly worse however. 6. Advanced facet arthropathy at L4-5 and L5-S1 and to a lesser degree at L3-4. 7. Unchanged mild chronic compression deformities and Schmorl nodes.