Muscle weakness. Evaluate for cauda equina syndrome Redemonstrated is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior, without residual marrow edema. As before, there is evidence of cement augmentation of the L3 vertebral body. Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen, which is unchanged. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.Degenerative changes are specified by the intervertebral level as follows and unchanged since 9/26/2016 and 3/31/2016. T12-L1: No spinal canal or neural foraminal stenosis, unchanged.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild spinal canal stenosis and bilateral mild to moderate neural foraminal stenosis. L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component resulting in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. These findings are unchanged.L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis. These findings are unchanged.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left. These findings are unchanged.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis, unchanged.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.
1.No significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the this level consistent with myelomalacia.2.Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation is unchanged in appearance. 3.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4.Degenerative changes at additional levels as detailed above which are unchanged.