An episode of incontinence in September. Continued left lateral hip pain. For the purpose of numbering, 5 lumbar type vertebrae are present with the last rib being at T12. In addition to straightening, there is lumbar levoscoliosis which can be better assessed with standing radiographs if indicated. The grade 1 anterolisthesis of L3 on L4 is grossly similar to prior with severe loss of disc height at the right aspect of the disc space and contributing to the levoscoliosis. Severe disc height and T2 signal loss at L3-L4 and L4-L5 has not significantly changed. Less severe degenerative disease at L1-L2, L2-L3 and L5-S1 discs is stable to minimally worse as described below. Heterogeneity of the marrow is most pronounced at L3, L4 and L5 vertebral bodies and is most likely degenerative in nature. Small Schmorl's node at the superior endplate of L4 is new since the previous examination. There is no suspicious marrow abnormality. The tip of the conus medullaris is at the mid L2 level, which is unchanged. The conus medullaris shows normal signal and morphology, as well as the included caudal spinal cord. Partially exophytic T1-hypointense, T2-hyperintense lesion arising from the inferior pole of the left kidney is incompletely assessed but was present previously and has not significantly changed in size.T10-T11, T11-T12 and T12-L1 (only in the sagittal plane): There are minimal disc bulges but no significant spinal canal stenosis. There is mild left T11-T12 neural foraminal stenosis.L1-L2: There is a minimal disc bulge associated with a tiny left foraminal protrusion but no significant spinal canal or left foraminal stenosis. There is mild, right more than left, facet arthropathy but no significant foraminal stenosis.L2-L3: Disc bulge is eccentric to the left. There is also ligamenta flava thickening and facet arthropathy. There is no significant spinal canal stenosis. There is no foraminal stenosis.L3-L4: Small disc bulge and disc uncovering related to grade 1 anterolisthesis which combined with advanced bilateral facet arthropathy and ligamentum flavum thickening result in moderate spinal canal stenosis which is stable to minimally worse in the interval. There is also no significant change in moderate to severe right and mild left foraminal stenosis, with possible impingement on the right L3 nerve root.L4-L5: Mild disc bulge and endplate osteophytes. The left greater than right facet arthropathy and the ligamenta flava thickening are not significantly changed. Mild central spinal and left subarticular recess stenoses are unchanged. There is moderate-to-severe left and mild right foraminal stenoses, which are unchanged with possible impingement of the left L4 nerve root. L5-S1: There is a disc bulge associated with a left foraminal and extraforaminal extrusion. Ligamentum flavum thickening and facet arthropathy with mild joint distention again seen. There is resulting in mild spinal canal stenosis. Severe left and mild-to-moderate right foraminal stenoses are also present. There may be impingement of the left L5 nerve root.
Multilevel degenerative changes in the lumbar spine are again seen which are stable to minimally worse in the interval. There is up to moderate spinal canal stenosis at the L3-L4 level. There is also significant neural foraminal stenosis on the right at L3-L4 and on the left at L4-L5 and L5-S1. There may be impingement of the left L4 and L5 nerve roots. Please see details above.