Female, 83 years old, with worsening back pain and gait abnormality, and right leg weakness. History of back surgery. Findings compatible with prior surgery are again seen at the L4-5 level where evidence of right-sided laminectomy and facetectomy is demonstrated.The lumbar lordosis is straightened similar to prior. A trace anterolisthesis of L4 relative to L5 has slightly progressed.Vertebral body marrow signal is mildly heterogeneous which likely represents a combination of inhomogeneous fat and superimposed degenerative endplate signal change.Degenerative disc disease has progressed at L4-5 with further loss of disc height. The remaining disc levels appear similar to the prior exam. Level specific findings are as follows below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.T12-L1: Facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Minimal bulging disc. Prominence of the epidural fat. Slight narrowing of the thecal sac without change. Mild left foraminal narrowing without change. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Mild bulging disc. Mild generalized narrowing of the spinal canal without change. Mild left foraminal narrowing without change. L4-5: Advanced left facet hypertrophy. Postoperative findings at the level of the right facet. Left anterior disc osteophyte slightly increased. Disc bulging and disc uncovering. Mild to moderate generalized spinal canal narrowing with medial displacement of the left-sided cauda equina nerve roots. Moderate right and severe left foraminal narrowing. No significant interval changes. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.
1.Postoperative findings compatible with right-sided laminectomy and facetectomy at L4-5.2.Progressive disc degeneration at L4-5 with further loss of disc height. The combination of disc degeneration and posterior element hypertrophy results in a mild to moderate generalized spinal canal narrowing asymmetric to the left without significant interval change. The L4-5 neural foramina are both significantly narrowed but without noticeable interval change.3.Degenerative findings at other levels are relatively mild and unchanged with the exception of multilevel anterior osteophytosis which has progressed but which does not affect the spinal canal or neural foramina.