History of spinal stenosis and worsening lower extremity pain and weakness. Evaluate for progression. Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris is grossly intact and terminates at L1 level. Again seen is moderate levoscoliosis which can be better assessed with standing radiographs. No significant spondylolisthesis.There are multilevel degenerative changes including disc desiccation throughout the lumbar spine with loss of disc height. There is severe disc height loss at the L4-L5 level and associated endplate changes which have progressed since 5/18/2011. There is mild increase in edema at the L4 and L5 endplates. Individual levels as below:At L1-2 there is mild disc bulge, ligamentum flavum thickening and facet arthropathy without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.At L2-3 there is a disc extrusion with mild superior migration along the right ventral thecal sac which is increased in the interval. There is also bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis at this level which is slightly progressed. There is also moderate bilateral neural foraminal stenosis right worse than left, which is similar to prior on the right and slightly worse in the interval on the left.At L3-4 there is disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis slightly worse in the interval. There is moderate to severe right and moderate left neural foraminal stenosis, similar to prior.At L4-5 there is severe spinal canal stenosis related to disc bulge, dorsal annular fissure, advanced facet arthropathy, and ligamentum flavum thickening. There is mild progression of these changes compared to prior. There is severe right and moderate left neural foraminal stenosis which is similar to prior.At L5-S1 there is disc bulge, ligamentum flavum thickening, and advanced facet arthropathy resulting in moderate to severe spinal canal stenosis similar to prior. There is also severe left and moderate right neural foraminal stenosis similar to prior.There is interval increase in paraspinous enhancement at the L3-L4 and L4-L5 levels which is likely related to facet arthropathy. Paraspinous soft tissues are otherwise unremarkable. No suspicious enhancing lesions. Small bilateral renal cysts incidentally noted.
1. Compared to 5/18/2011 there is mild progression of advanced degenerative changes in the lumbar spine. There is severe spinal canal stenosis at L4-L5, moderate to severe spinal canal stenosis at L5-S1, and moderate spinal canal stenosis at L2-L3 and L3-L4.2. There is significant neural foraminal stenosis at L2-L3, L3-L4, L4-L5, and L5-S1 levels as detailed above where there may be impingement of the exiting nerve roots.3. There is lumbar levoscoliosis which can be further assessed with standing radiographs. 