Diagnosis: Spinal stenosis, lumbar regionClinical question: assess for progression of lumbar stenosisSigns and Symptoms: severe radicular pain, claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is mild dextrocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild right far lateral disc protrusion present at this level. There is mild ligamentum flavum hypertrophy present.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level. There is mild to moderate degree of bilateral facet and ligamentum flavum hypertrophy at this level. There is a left far lateral disc protrusion at this level. There is effacement of the fat surrounding the left-sided exiting nerve root at this level resulting in some mild encroachment of the left-sided exiting nerve root within the neural foramen. Overall there is no significant change when compared to the prior exam.At L3-4 there is redemonstration of marked bilateral facet hypertrophy associated with anterior subluxation of L3 on L4 which is stable compared to the prior exam. There is uncovering of the disc with some disc material extending into the neural foramina. There is loss of disc space height and disc desiccation at this level. There is compression of the thecal sac with partial effacement of the spinal fluid within the thecal sac, flattening of the thecal sac and partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. Overall there is moderate to severe spinal stenosis at this level which has not changed significantly compared to the previous exam. There is mild right lateral translation of L3 on L4.At L2-3 there is redemonstration of anterior subluxation of L2 on L3, loss of disc space height, disc desiccation and uncovering of disc material. There is marked bilateral facet hypertrophy at this level. There is compression of the thecal sac with near complete effacement of the spinal fluid within the thecal sac, flattening of the thecal sac. Overall there is marked spinal stenosis at this level which has not changed significantly compared to the previous exam. Overall there is no significant change compared with previous exam.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level
1.There are multilevel degenerative changes present in the lumbar spine with subluxations at L2-3 and L3-4 and severe spinal stenosis at L2-3 and moderate to severe spinal stenosis at L3-4 . There is encroachment of exiting nerve roots within the right neural foramen at L4-5. This has not progressed substantially compared to the March exam.