Diagnosis: Other alteration of consciousnessClinical question: eval lumbar disc Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior fusion at L3-4, L4-5 and L5-S1 associated with bilateral pedicle screws at L3, L4, L5 and S1. Patient is status post laminectomies at L4 and L5. There is anterior wedging of the L3 vertebral body. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level associated with effacement of the fat surrounding the exiting nerve roots within the neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.There is mild anterior subluxation of L3 and L4. There is ligamentum flavum hypertrophy present at this level as well as facet hypertrophy.At L2-3 there is a large left lateral recess disc extrusion present with disc material extending behind the L2 and L3 vertebral bodies and compressing the thecal sac and effacing spinal fluid surrounding the nerve roots of the cauda equina at this level. On sagittal imaging the disc extrusion measures approximately 26 x 11 mm sagittal dimensions. There is also a left far lateral disc protrusion at this level which displaces the left-sided exiting nerve root after it exits the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.Examination is degraded by patient motion which may obscure more subtle abnormalities.There is atrophy of the left psoas muscle.
1.There is a large disc extrusion at L2-3 which create significant spinal stenosis.2.The patient is status post lower lumbar spine surgery as described above with posterior fusion and laminectomies3.The examination is degraded by patient motion which may obscure more subtle abnormalities. No T1 axial images were acquired because of patient's inability to tolerate further imaging