36-year-old female with sciatica. Rule out cord compression. Five lumbar type vertebral bodies are presumed to be present. Again seen is trace grade 1 retrolisthesis of L5 on S1, without significant interval change. The remainder of the lumbar spine is normal in alignment, with straightening of the normal lumbar lordosis. Bone marrow signal is benign. Degenerative endplate bone marrow changes are noted at the L5-S1 level. Vertebral body heights are within normal limits. There is disc desiccation at the L4-L5 and L5-S1 levels with mild loss of intervertebral disc height at the L5-S1 level. The spinal cord is normal in signal. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis.L5-S1: There are interval postoperative changes from left hemilaminectomy and microdiscectomy. Again seen is a disc bulge with large leftward central disc extrusion, the original component of which appears smaller than the prior exam. However, there is new, ill-defined soft tissue material contiguous with the L5-S1 disc effacing the left aspect of the spinal canal and causing at least moderate spinal canal stenosis. There is possible impingement of the left L5 and sacral nerve roots with mild left neural foraminal stenosis. Mild facet arthropathy is also noted.There is a small amount of fluid in the laminectomy bed, as well as a small amount of dorsal epidural fluid just superior to the laminectomy, which may be within normal limits in the recent postoperative period. The epidural fluid contributes the spinal canal stenosis.
1. Findings compatible with interval L5-S1 left hemilaminectomy and microdiscectomy. While the original leftward central disc extrusion at this level appears somewhat smaller, there is new, ill-defined soft tissue contiguous with the disc which effaces the left thecal sac and potentially impinges the adjacent nerve roots. Differential diagnosis includes scar tissue versus recurrent disc.2. Fluid in the laminectomy bed and a small amount of dorsal epidural fluid just above the laminectomy level. Findings may be within normal limits in the recent postoperative period.