Left lower extremity radiculopathy. Evaluate for L5-S1 stenosis. There has been interval spinal fusion at L4-L5 level via posterior rods and screws and an intervertebral disc space device. The vertebral column alignment is near-anatomic. The vertebral body heights are preserved. There is intervertebral disc desiccation at L3-L4, L4-L5 and L5-S1. There is also facet hypertrophy and ligamentum flavum thickening at various levels. At L3-L4, there is mild left foraminal disc protrusion resulting in mild encroachment at the left lateral recess and left neural foramen. At L4-L5, there is no significant residual spinal canal or neural foraminal narrowing. The disc protrusion superimposed upon a mild disc bulge at L5-S1 appears to have decreased in size, but there is persistent bilateral neural foraminal stenosis, primarily due to facet hypertrophy, and there is no significant spinal canal. The spinal cord displays normal signal and morphology.
1. Interval spinal fusion at L4-L5, without evidence of significant spinal canal or neural foraminal stenosis at this level. 2. Apparent decrease in size of the disc protrusion at L5-S1, but persistent bilateral neural foraminal stenosis primarily due to facet hypertrophy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.