Low back pain and right upper thigh pain. History of lumbar laminectomy. Evaluate for stenosis or disc herniation. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level. There is fibrofatty infiltration of the filum terminale which measure up to 2 mm in diameter at the L5-S1 level.There are postsurgical changes of laminectomy at the L2-L4 levels. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc desiccation with mild height loss. Mild disc bulge and mild bilateral facet arthropathy. There is associated effacement of the right lateral recess. There is mild right and minimal left neural foraminal stenosis. Central canal is surgically decompressed.L3-L4: Disc desiccation with mild height loss and mild bulge. Mild bilateral facet arthropathy. There is mild effacement of the lateral aspects of the spinal canal, which is otherwise surgically decompressed. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is vacuum disc phenomena with disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening which contribute to severe spinal canal stenosis just below the laminectomy. There is also moderate to severe bilateral, right greater than left, neural foraminal stenosis. L5-S1: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is effacement of the lateral recesses. There is mild to moderate bilateral neural foraminal stenosis. There is also mild central canal stenosis. There are postsurgical changes in the posterior paraspinous soft tissues, which are otherwise unremarkable.
1. Postsurgical changes of prior laminectomy from L2 to L4 levels. There are multilevel degenerative changes, worst at the L4-L5 level, where there is severe spinal canal stenosis just below the laminectomy. There is also moderate to severe neural foraminal stenoses at this level, right greater than left. 2. Milder degenerative changes at additional levels as above.3. Fibrofatty infiltration of the filum terminale incidentally noted. Conus terminates in normal position at the L1-L2 level.