Chronic bilateral lower extremity pain, no weakness. Evaluate for cord or nerve root compression. Five lumbar type vertebral bodies are presumed to be present. There are postsurgical changes of laminectomy from L3-L4 to the L5-S1 levels. There is enhancement involving the posterior paraspinous soft tissues compatible with granulation tissue. Vertebral body heights are normal. There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. Conus is in normal position. There are multilevel degenerative changes, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild disc bulge with small dorsal annular fissure. Small extrathecal collection is noted along the left lateral aspect of the thecal sac without mass effect and compatible with postsurgical change. Prior laminectomy. No significant spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis. There is facet arthropathy, relatively worse on the left. L4-L5: Disc desiccation and disc bulge. Grade 1 anterolisthesis. There is advanced bilateral facet arthropathy. Evidence of prior laminectomy without significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.L5-S1: Minimal disc bulge including a small central protrusion. Prior laminectomy. There is no significant spinal canal stenosis. There is advanced bilateral facet arthropathy. No significant spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis. No suspicious enhancing lesions are appreciated. There is enhancement associated with the facet arthropathy at the L3-L4, L4-L5, and L5-S1 levels which is likely on a degenerative basis.
1. Multilevel degenerative changes in the lumbar spine with evidence of prior laminectomies from L3-L4 to the L5-S1 levels. There is no significant spinal canal stenosis at any level. There are varying degrees of mild to moderate neural foraminal stenosis bilaterally at the L3-L4, L4-L5, and L5-S1 levels as described above.2. Advanced facet arthropathy at the L4-L5, L5-S1, and to a lesser degree at the L3-L4 levels.