Pain right anterior thigh and bilateral L5 distribution Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening and grade 1 L4-L5 anterolisthesis which was present previously. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the left and bilateral facet arthropathy. No spinal canal stenosis.L3-L4: Mild disc bulge eccentric to the left with small left sided annular fissure. Mild bilateral facet arthropathy. There is mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.L4-L5: There are postsurgical changes of interbody fusion with interbody implant and left lateral screws at the L4 and L5 vertebral bodies. There is advanced bilateral facet arthropathy which along with mild disc bulge contribute to mild right and moderate to severe left neural foraminal stenosis as well as mild to moderate central spinal canal stenosis. There is also effacement of the bilateral lateral recesses. These findings are all mildly progressed since 11/13/2014.L5-S1: Spinal canal is developmentally small at this level with termination of the thecal sac. No high-grade central spinal canal stenosis. No significant disc disease. There is bilateral facet arthropathy with mild effacement of the lateral recesses. Neural foramina are patent. There is edema involving the bilateral psoas muscles as well as a small fluid collection along the left psoas muscle which may be postoperative.
Postsurgical changes of interbody fusion at the L4-L5 level via left lateral retroperitoneal approach. There is mild right and moderate to severe left neural foraminal stenosis at this level related to disc bulge and advanced facet arthropathy. There is also effacement of the lateral recesses at this level and mild to moderate central spinal canal stenosis. These findings have mildly progressed since 11/13/2014.