Bowel incontinence and right foot drop. The examination was initially requested with and without contrast. However, given the lack of intravenous access, it was changed to a noncontrast-enhanced examination.THORACIC SPINE:Multilevel cervical degenerative disc-osteophyte complexes mildly narrow the spinal canal and were present on the previous examination of February 2015.Thoracic spinal alignment is anatomic. The marrow is heterogeneous and less fatty than expected but shows no suspicious lesion on the fat-saturated sequences and is unchanged since February 2015. Vertebral body heights are preserved. There is multilevel disc desiccation but no significant disc bulge or herniation. The spinal canal is preserved. There is no neural foraminal stenosis also. The spinal cord is normal in signal and shape.The upper thoracic esophagus is slightly prominent which is nonspecific but may reflect esophagitis. There are small T2-hyperintense lesions in the liver which are not completely assessed but were present on the previous examination.LUMBAR SPINE:For the purpose of vertebral level numbering, there is partial lumbarization of S1 (the last well-formed disc is at S1-S2).There is new anterior subluxation at L4-L5 which along with other degenerative changes contribute to moderate spinal canal stenosis as described below. Otherwise, alignment is anatomic and the vertebral bodies are preserved in height. The marrow is heterogeneous and less fatty than expected but shows no suspicious lesion on the fat-saturated sequences and is unchanged since February 2015. Marrow edema-like signal involving the apposing parts of the spinous processes of L4 and L5 may reflect Baastrup disease. Lumbar disc desiccation relatively spares L1-L2 and L5-S1. There is moderate disc height loss at the subluxed L4-L5 level. The tip of the conus medullaris is at L2 level. The conus medullaris has normal shape and signal.T12-L1 and L1-L2: There is no significant spinal canal or neural foraminal stenosis. There is mild facet arthropathy at L1-L2.L2-L3: Minimal disc bulge is eccentric to the right and along with mild facet arthropathy results in minimal, if any, foraminal narrowing but no significant spinal canal stenosis.L3-L4: Minimal disc bulge causes no significant spinal canal or neural foraminal stenosis.L4-L5: The disc bulge and uncovering along with moderate-to-severe facet arthropathy (with minimal joint effusions) and moderate ligamentum flavum thickening result in moderate central spinal canal and mild-to-moderate neural foraminal stenoses. This has increased since the previous examination.L5-S1: Disc bulge along with moderate facet arthropathy and mild-to-moderate ligamentum flavum thickening result in mild bilateral neural foraminal but no significant spinal canal stenosis.S1-S2: There is no spinal canal or neural foraminal stenosis.
1.No spinal cord compression.2.No significant degenerative change or other abnormality of the thoracic spine.3.New, since February 2015, anterior subluxation and slightly increased degenerative disease at L4-L5 resulting in moderate central spinal canal and mild-to-moderate neural foraminal stenoses.4.Minimal edema-like signal involving the apposing parts of the spinous processes of L4 and L5 may reflect Baastrup disease. 5.Diffuse marrow abnormal signal is unchanged since February 2015 and may relate to HIV infection.6.Upper thoracic esophagus mucosa is slightly prominent which is nonspecific but may reflect esophagitis. Small T2-hyperintense lesions in the liver are not completely assessed but were present on the previous examination.7.Transitional lumbosacral anatomy. If surgery is to be contemplated, correlation with imaging of entire spine is recommended.