Patient with L5-S1 discogenic DJD and now with new low back pain not responding to conservative measures. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are grossly within normal limits. Again seen is dextroscoliosis of the lumbar spine centered at the L3 level. Bone marrow signal is benign. 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: Mild disc bulge and mild facet arthropathy. Spinal canal and right neural foramen are patent. Left neural foramen is narrowed with mild to moderate neural foraminal stenosis similar to prior.L2-L3: Mild disc bulge eccentric to the left, bilateral facet arthropathy, and ligamentum flavum thickening. There is partial effacement of the left lateral recess as before. Central spinal canal remains patent. There is moderate left-sided neural foraminal stenosis as before. Right neural foramen is patent. L3-L4: Mild disc bulge eccentric to the left, ligamentum flavum thickening, and advanced facet arthropathy. There is distention of the left facet joint which was present previously. There is mild to moderate left neural foraminal stenosis. Right neural foramen is patent. Mild effacement of the left lateral recess. Minimal narrowing of the spinal canal similar to prior. L4-L5: Mild disc bulge and advanced bilateral facet arthropathy. Mild effacement of the right lateral recess. There is no significant central canal stenosis. There is moderate degree of right-sided neural foraminal stenosis. Mild left neural foraminal narrowing. Noted is clumping and peripheral displacement of the cauda equina nerve roots particularly on the right suggestive of arachnoiditis which is new since prior. L5-S1: Severe disc height loss particularly in the right aspect of the disc space and similar to prior. Mild disc bulge. Advanced right-sided facet arthropathy. There is severe right neural foraminal stenosis which was present previously. Left neural foramen is patent. Spinal canal is patent.Lower lumbar posterior paraspinous musculature demonstrates asymmetric atrophy on the right similar to prior.
1. Degenerative changes throughout the lumbar spine with significant dextroscoliosis centered at the L3 level similar to prior. There is no significant central spinal canal stenosis at any level. There is multilevel neural foraminal stenosis as detailed above, which is severe at the right L5-S1 level. Please see additional levels of neural foraminal stenosis as detailed above.2. There is advanced facet arthropathy at the bilateral L3-L4, bilateral L4-L5, and right L5-S1 levels, which may be contributing to patient's low back pain.3. There is clumping and peripheral displacement of the cauda equina nerve roots in the lower lumbar spine particularly on the right, which is new since prior MRI from 12/23/2014. Findings suggest arachnoiditis. Correlate with history for possible spine procedure in the interval as a potential etiology.