Pain, evaluate stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis at L4 on L5 which appears slightly worse since 2/25/2013 on the supine MRI images, further evaluation with flexion-extension radiographs can be considered as clinically indicated. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Unchanged subcentimeter lesion at the S2 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and some loss of height. Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal stenosis.L4-L5: There is disc uncovering and disc bulge and advanced bilateral facet arthropathy. There is mild spinal canal stenosis. There is moderate bilateral neural foraminal stenosis, worse on the left than the right. L5-S1: Diffuse disc bulge with small central protrusion. Advanced facet arthropathy with mild distention. There is partial effacement of the lateral recesses without significant central canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.
1. Multilevel degenerative changes as detailed above with grade 1 degenerative spondylolisthesis at L4 on L5. There is mild spinal canal stenosis and moderate bilateral neural foraminal stenosis at L4-5. There is partial effacement of the lateral recesses and mild to moderate foraminal narrowing at L5-S1 as described above. There is overall mild progression since 2/25/2013.2. Subcentimeter well-circumscribed lesion at the S2 vertebral body remains unchanged and most likely benign given stability since 2012.3. Advanced facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.