Displacement of lumbar intervertebral disc without myelopathy. History of discectomy. Now with low back pain and difficulty ambulating distance Five lumbar type vertebral bodies are presumed to be present. There is 25% loss of vertebral body height redemonstrated at L2 elated to superior endplate compression and mild anterior subluxation of L4 on L5 redemonstrated. Compared to the February exam there is no significant change in the appearance of either the compression fracture or the subluxation. There is multilevel disk desiccation present.The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with mild ligamentum flavum and facet hypertrophy.At L4-5 there is diffuse disk bulge associated marked bilateral facet hypertrophy with associated effacement of the fat at the lateral recesses. Since the previous exam the patient has undergone left-sided hemilaminectomy at this level. The thecal sac is enlarged on the current exam relative to the prior. The cerebral spinal fluid surrounding the nerve roots is not effaced though the thecal sac is smaller than at other levels. There is associated narrowing of the neural foramina bilaterally and mild effacement of the fat surrounding the exiting nerve roots within the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. There is enhancement of the soft tissues at the lateral recesses and surrounding the thecal sac at this level. There is associated mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level and a minor disk bulge.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a small cyst present in the right kidney measuring 6 mm in diameter.
1.Since the prior exam the patient has undergone surgery at L4-5. The spinal canal has enlarged. There is less ligamentum flavum hypertrophy at this level now and mild narrowing of the spinal canal which is a significant improvement since the prior exam. There is however some suspicion for scar formation at the lateral recesses at this level involving the nerve roots at the lateral recesses.2.There is a benign-appearing chronic compression fracture at L2.