Persistent low back pain despite all appropriate nonoperative measures. For the purposes of numbering, there are 5 lumbar vertebrae--with small ribs associated with L1, as numbered previously. The vertebral column alignment is within normal limits. There is mild anterior wedging of the L1 vertebral body as seen previously without marrow edema. Again seen is disc desiccation with height loss involving the L3-L4 disc, minimally worse since 11/2/2015. Disc desiccation is also evident at L4-L5 and to an even lesser degree at L5-S1 without height loss. Again seen are edematous endplate changes involving the superior endplate of L4 as well as inferior endplate of L3, which have slightly progressed since prior. No suspicious osseous lesions are evident.There is no significant spinal canal stenosis. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is a tiny disc bulge but no significant compromise to the spinal canal or neural foramina.L1-L2: There is no significant compromise to the spinal canal or neural foramina.L2-L3: There is no significant compromise to the spinal canal or neural foramina.L3-L4: Again seen is disc bulge with left foraminal disc extrusion component which causes mild to moderate left neural foraminal stenosis and effacement of the left lateral recess. There is mild right neuroforaminal narrowing. There is mild facet arthropathy with distention of the facet joints similar to prior. There is minimal central spinal canal narrowing.L4-5: There is a mild disc bulge and mild facet arthropathy which causes mild left neural foraminal stenosis. There is no significant right neuroforaminal or central canal stenosis. L5-S1: There is no significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.
1. Compared to 11/2/2015, there is slight progression of degenerative disc endplate changes at the L3-L4 level with mild increase in edema involving the adjacent endplates. There is mild to moderate left neural foraminal stenosis related to disc extrusion at this level similar to prior. There is also facet arthropathy at this level with mild distention of the facet joints. 2. Mild degenerative changes at additional levels as described above which are not significantly changed since prior. Mild anterior wedging of L1 vertebral body without edema again seen.3. Please note numbering scheme above with hypoplastic ribs associated with the L1 vertebral body, as numbered previously.