History of prior spine surgery now with increasing low back pain and lower extremity paresthesias. The vertebral body heights are preserved. Alignment is anatomic. There is decreased signal and loss of disc height at L4-5 and L5-S1 compatible with disc degeneration. Reactive endplate marrow signal is present in the L4-S1 vertebral bodies. The conus medullaris terminates at the mid L2 level. Partially visualized mass within the right paraspinal musculature at the level of T12 has fat signal characteristics. While this appears to have mildly enlarged since 2004, it did not enhance on the previous study and is compatible with an intramuscular lipoma.Level by level findings are as follows: T12-L1: No disc bulge. Moderate facet arthropathy and hypertrophy of the ligamentum flavum. No significant spinal canal or neural foraminal stenosis.L1-L2: Mild facet arthropathy. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: Diffuse disc bulge, moderate facet arthropathy and hypertrophy of the ligamentum flavum creates mild bilateral neural foraminal stenosis. Mild to moderate spinal canal stenosis accentuated by epidural fat. L3-L4: Moderate bilateral facet arthropathy. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Post surgical changes from bilateral laminectomy. Moderate diffuse disc bulge. Moderate to severe facet hypertrophy. Moderate left and severe right neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Post surgical changes from bilateral laminectomy. Mild diffuse disc bulge. Moderate facet hypertrophy. Moderate right and severe left neural foraminal stenosis. No significant spinal canal stenosis.
1. Post surgical changes from prior L4 and L5 bilateral laminectomies.2. Multilevel degenerative disc disease and degenerative arthritic changes which create multilevel neural foraminal stenoses. This is most severe involving the right L4-5 and left L5-S1 neural foramen.