49 year-old female with low back pain. Additional history per chart, prior L3-L4 discectomy. 5 lumbar type vertebral bodies are presumed. Vertebral body heights are maintained. There is minimal retrolisthesis of L5 on S1 as well as straightening of the lumbar curvature similar to prior. Again seen is fatty infiltration involving the filum terminale with more focal lipoma along the filum measuring 4 mm at the L2 level, inferior to the conus which terminates normally at the L1-L2 level.Slightly prominent epidural fat in the distal sacral spinal canal is felt to represent an anatomic variant. Marrow signal is benign. Multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Previously seen left paracentral disc extrusion has resolved. There remains a mild disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: Asymmetric disk bulge to the right with loss of disk height. There is mild bilateral, right greater than left, neural foraminal stenosis and also contact of the right extraforaminal L3 nerve root. This finding is stable to minimally worse since 7/15/2013. Again seen is atrophy of the right paraspinous musculature likely reflective of prior surgery for discectomy. No significant central spinal canal stenosis.L4-L5: Disc bulge with an eccentric portion involving the left extraforaminal segment and mild bilateral facet arthropathy. Disc height loss appears minimally worse. Mild to moderate left and mild right neural foraminal stenosis, minimally worse in the interval. No significant central spinal canal stenosis.L5-S1: Disc bulge and mild bilateral facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis stable to minimally worse (on the right) since prior. There is contact and mild lateral displacement of the extraforaminal right L5 nerve root. Conjoined right S1 and S2 nerve roots incidentally noted.
1. Mild to moderate multilevel degenerative changes in the lumbar spine have overall minimally changed from MRI from 7/15/2013. No significant central spinal canal stenosis at any level. Please see additional details above. 2. Lipomatous infiltration of the filum terminale again seen, measuring up to 4 mm in thickness at L2. Conus is in normal position at the L1-L2 level but would suggest correlation with clinical signs of cord tethering.