86-year-old female with severe degenerative disk disease and pain. History of metastatic breast cancer and L3 L5 laminectomy Vertebral body heights are intact. There are degenerative endplate marrow signal changes at L2-L3 and L3-L4. Bone marrow edema seen on the prior exam at these levels has resolved. Focal increased T1 and T2 signal within the left L4 lamina and T12 vertebral body without enhancement are unchanged and likely represent hemangiomas. No abnormal enhancement is seen throughout the lumbar spine to suggest metastases. There is severe degenerative disk disease with disk desiccation at all levels and severe disk space narrowing at L4-L5, L3-L4, and L2-L3, not significantly changed since the prior exam. Multiple small Schmorl's nodes are noted. There is grade 1 anterolisthesis of L4 relative to L3. Signal within the distal cord and conus is normal. Postsurgical changes of L3 and L5 laminectomies are redemonstrated with increased STIR signal within the operative bed, likely representing scarring.T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: Mild diffuse disk bulge. Mild facet arthropathy and ligamentum flavum hypertrophy. No spinal canal or neuroforaminal stenosis.L2-L3: Mild diffuse disk bulge, asymmetric to the right, is worse than the prior exam. Mild facet arthropathy and ligamentum flavum hypertrophy. Mild central canal stenosis, unchanged. Mild bilateral neuroforaminal stenosis, unchanged.L3-L4: Diffuse disk bulge with left paracentral extrusion extending inferiorly is decreased in size from the prior exam. There is moderate facet arthropathy. Moderate central canal stenosis is improved from the prior exam. Severe right-sided neuroforaminal stenosis is worse than the prior exam. Moderate left-sided neural foraminal stenosis is unchanged.L4-L5: Mild diffuse disk bulge with new annular fissuring within the disk on the left. Mild facet arthropathy. No spinal canal stenosis. Minimal bilateral neuroforaminal stenosis.L5-S1: Diffuse disk bulge is unchanged. No spinal canal stenosis. Moderate bilateral neuroforaminal stenosis, unchanged.Partially visualized bilateral renal cysts with a cyst adjacent to the right kidney are unchanged.
1.Severe degenerative disk disease without evidence of metastatic disease or compression fracture.2.Postsurgical changes with improvement in central canal stenosis and herniation at the L3-L4 level, however right-sided neuroforaminal stenosis at this level has increased.3.Asymmetric disk bulge at L2-L3 is slightly worst with mild bilateral spinal canal and neuroforaminal stenosis at this level.4.Additional multilevel neuroforaminal narrowing is unchanged.