 The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are stable, with mild disc narrowing again noted L2-L3 and L3-L4, with progression of now diffuse disc desiccation. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles and slight prominence of dorsal epidural fat. There is slight thickening and redundancy of cauda equina nerve roots secondary to spinal stenosis as detailed below.Sagittal images again demonstrate a minimal disc bulge with left-sided prominence at T10-T11.At T11-T12, there is a shallow left paracentral disc protrusion with mild bilateral facet arthropathy and ligamentum flavum thickening.At T12-L1, there is no significant disk pathology or stenosis.At L1-L2, there is now a mild disc bulge with bilateral facet arthropathy and ligamentum flavum thickening again seen. There is mild central spinal canal stenosis and minimal left foraminal narrowing.At L2-L3, there is a mild to moderate disc bulge with significant bilateral facet arthropathy and ligamentum flavum thickening resulting in overall mild-moderate central spinal canal stenosis and minimal bilateral foraminal narrowing.At L3-L4, there is a stable mild diffuse disc bulge with moderate bilateral facet arthropathy and ligamentum flavum thickening resulting in overall mild central spinal canal stenosis. There is mild-moderate right and mild left foraminal narrowing. There is again abutment of the exiting right greater than left L3 nerve root.At L4-L5, there is redemonstration of a mild disc bulge. There is severe bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe central spinal canal stenosis and mild bilateral foraminal narrowing. There is lateral recess narrowing with again impingement of the bilateral descending L5 nerve roots.At L5-S1, mild disc bulge significant bilateral facet arthropathy and ligamentum flavum thickening. There is abutment of the descending S1 nerve roots bilaterally by disc material. There is no significant stenosis.
Slight interval progression of multilevel spondylotic changes within the lumbar spine with up to moderate-severe central spinal canal stenosis at L4-L5 due to disc disease as well as facet arthropathy and ligamentum flavum thickening. Impingement of descending L5 nerve roots bilaterally at this level. Underlying developmental narrowing of the lumbar spinal canal also noted.