Diagnosis: LumbagoClinical question: rule foraminal compression in the L-spineSigns and Symptoms: Anterior thigh radicular symptoms Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There are 4 non-rib bearing vertebra present and L5 appears to be sacralized. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.Patient is status post lower lumbar spine surgery at L4 -- 5 and L3-4.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is status post surgery. Some soft tissue is present along the lateral recess bilaterally which displayed contrast enhancement on the prior exam which mas more on the right versus the left side. The fat at the lateral recess is bilaterally effaced. There is also loss of disk space height, disk desiccation and a disk bulge at this level. There is effacement of the fat of the lateral recesses bilaterally at this level as well as at bilateral facet hypertrophy and bilateral laminotomies with removal of ligamentum flavum. Overall, the thecal sac appears stable compared to the preoperative exam.At L3-4 there is is effacement of the fat of the lateral recesses bilaterally at this level as well as at bilateral facet hypertrophy and bilateral laminotomies with removal of ligamentum flavum. There is a Schmorl's node at this level. There is redemonstration and no change of effacement of the fat surrounding the right exiting nerve roots at this level and milder narrowing of the left neural foramen. Overall, the thecal sac appears larger on the current exam versus the preoperative exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is redemonstration of a minor disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Please note that L5 is partially sacralized. This affects enumeration of the lumbar vertebra2.The patient is status post lumbar spine surgery at L3-4 and L4-5 with laminotomies and removal of a ligamentum flavum.3.There is soft tissue present at the lateral recesses at L4-5 surrounding the nerve roots at the right lateral recess right more than left and at the L3-4 lateral recess bilaterally. The possibility that this represents some scar formation at the site is suggested. This has not changed substantially since the prior exam. Please note that contrast enhanced exams are more sensitive in evaluating for scar formation. Please correlate with clinical symptoms.4.There is mild to moderate encroachment of the right exiting nerve roots at the L4-5 level within the neural foramen.5.A note by the technologist indicates that the axial T2 continuous images were omitted by error. The technologist in DCAM indicated that he would contact the patient and offer this additional sequence to the patient.