Male, 76 years old, with low back pain and leg pain, history of fusion from T11 to L3, assess for stenosis below the fusion. Susceptibility artifact induced by posterior spinal fusion instruments results in signal loss and obscuration of the vertebral bodies and spinal canal from T11 through L2. Within this limitation, the following observations are made.A grade 1 retrolisthesis of L2 relative to L3 appears to have progressed from the prior MRI, though it is stable dating back to a CT from 9/16/2014. A grade 1 anterolisthesis of L4 relative to L5 is new from prior exams.The known L1 vertebral body compression fracture is not well assessed due to artifact. The visualized vertebral bodies demonstrate preservation of height. The visualized marrow space shows no evidence of concerning marrow replacement or pathologic enhancement.As on the prior MRI, the spinal canal and its contents are not assessed from T11 through L2. Additional level specific findings are as follows:L3-4: Evidence of prior laminectomy. The facet joints are hypertrophic and the ligamentum flavum is thickened, similar to prior. Very mild progressive loss of disc height with bulging disc, slightly asymmetric to the right. Moderate spinal canal stenosis with slight crowding of the cauda equina, unchanged. The neural foramina are not adequately assessed due to artifact from pedicle screws. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Slight progression of loss of disc height and bulging disc which is asymmetric to the right foraminal zone. Moderate generalized spinal canal stenosis which may be mildly progressed at the level of the right lateral recess. Severe right and moderate left foraminal narrowing, both very slightly progressed. L5-S1: Facet hypertrophy, marked on the right, but unchanged. Ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe right and mild to moderate left foraminal narrowing without significant interval change. Bilateral renal cystic lesions are again seen without interval change.
1.As on the prior MRI examination, the spinal canal and vertebral bodies are not adequately assessed from T11 through L2 secondary to artifact induced by the orthopedic instrumentation.2.Below the level of the fusion, mild progressive degenerative disease is seen. In particular, there is new spondylolisthesis at L2-3 and L4-5. Also noted is progressive mild loss of disc height at L3-4 and L4-5. A slight progressive narrowing of the right lateral recess at L4-5, as well as progressive narrowing of the L4-5 foramina, are suspected.