Female, 52 years old, with worsening lower extremity numbness. Since the prior examination, the patient has undergone laminectomy at L4, L5 and S1 with expansion of the thecal sac through this region. The vertebral bodies are otherwise intact. No evidence of suspicious marrow replacement or marrow edema is seen. Spinal alignment is anatomic.Visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are seen.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening, progressed from prior. No significant spinal canal or neuroforaminal stenosis. L3-4: Advanced facet hypertrophy and ligamentum flavum thickening, particularly on the left, progressed from prior. Minimal disc bulging with a trace right foraminal annular fissure, not significantly changed. Moderate generalized spinal canal stenosis, to which prominence of the dorsal epidural fat contributes, progressed from prior. Moderate right and mild left foraminal narrowing, progressed. L4-5: Advanced facet hypertrophy, particularly on the left, progressed. Surgical thinning of the ligamentum flavum. Minimal bulging disc with a small right foraminal and far lateral protrusion, not significantly changed. The spinal canal is decompressed. Moderate right and mild left foraminal narrowing, slightly progressed. L5-S1: Moderate facet hypertrophy, similar to prior. Surgical thinning of the left ligamentum flavum. Progressive loss of disc height with disc bulge and endplate osteophytic spurring. The previously seen large left paracentral protrusion is significantly smaller. Previous significant spinal canal stenosis is relieved with surgical decompression. Mild effacement of the left lateral recess persists. There may be mild residual impingement of the left transiting S1 nerve root. Moderate to severe bilateral foraminal narrowing, not significantly changed.
1. Evidence of interval laminectomy and spinal canal decompression spanning from L4 through S1.2. Although the L5-S1 disc shows progressive loss of height, the previously seen large disc herniation at this level, and associated severe spinal canal stenosis, are much improved. The neural foramina remain moderately to severely narrowed at this level, similar to prior.3. Progression of facet arthropathy and ligamenta flava thickening is seen at other levels as detailed above. Most notably, the L3-4 level demonstrates a moderate generalized spinal canal narrowing which is progressed from prior.