Low back pain and buttock pain, and left calf pain for 3 to 4 weeks. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Severe loss of disc space at the L3-L4 level as well as grade 1 retrolisthesis again seen and similar to prior. There remains bone marrow edema involving the L3 and L4 vertebral bodies as well as the superior L5 endplate, which is slightly worse than 1/27/2016. No evidence of recurrent disc herniation at the L3-L4 level. There is a disc extrusion with inferior migration involving L4-L5 level which is increased since prior. There is effacement of the left lateral recess as well as narrowing of the left L4-L5 foramen. Post gadolinium images demonstrate abnormal diffuse enhancement involving the intrathecal left L5 nerve root likely reflecting inflammation from compression. Additional details of the degenerative changes are described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Severe loss of disc height and mild retrolisthesis. There is mild narrowing of the left lateral aspect of the spinal canal related to facet arthropathy, otherwise no significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing and mild left neural foraminal narrowing. Evidence of prior discectomy on the right. No significant change since most recent prior.L4-L5: There is moderate to severe spinal canal stenosis related to combination of facet arthropathy, ligamentum flavum thickening, and disc extrusion with inferior migration. Left lateral recess and foraminal left foraminal disc extrusion as described above is slightly worse since prior. Abnormal enhancement involving the dorsal epidural space at L4-L5 favored to represent granulation tissue and present previously. There is moderate to severe narrowing of the left neural foramen and lateral recess effacement which are slightly worse. Mild right neural foraminal narrowing. Distention of the facet joints is again seen and perhaps minimally worse. There is advanced left-sided facet arthropathy with small synovial cyst suspected posterior to the left facet joint adjacent to a T1 hyperintense, presumable osseous spur, which can be confirmed with CT. Abnormal enhancement is also noted at the left L4-L5 paraspinous region which is favored to represent inflammation with a 9 mm T2 hyperintense possibly representing a synovial cyst within this region. L5-S1: Disc height loss and mild bulge. Mild facet arthropathy. No significant spinal canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis.
Moderate to severe central spinal canal stenosis at L4-L5 with mild worsening of left lateral recess stenosis and left foraminal stenosis related to disc extrusion which is worse in the interval. There is suspected impingement of the left L5 nerve root at this level which also demonstrates enhancement in its intrathecal course. There may also be impingement of the left L4 nerve root at the level of the neural foramen at this level.There is advanced facet arthropathy at the left L4-L5 level with abnormal enhancement dorsal and lateral to the left facet joint. There appear to be small presumed synovial cysts in these regions. Findings may be on a degenerative basis but would suggest correlation with clinical findings for the small possibility of infection. These findings have gradually progressed when compared to multiple prior lumbar spine studies.Additional levels as above.