Diagnosis: Spinal stenosis, lumbar regionClinical question: chronic L5 radiculopathySigns and Symptoms: chronic low back and left pain 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disc desiccation present. The patient is status post right hemilaminectomy at L3-4. Soft tissue swelling associated with the surgical site has evolved since the prior exam and is less prominent.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is moderate bilateral facet and ligamentum flavum hypertrophy present associated with loss of disc space height, disc desiccation and diffuse disc bulge. There is encroachment of the exiting nerve roots within the neural foramina at this level. There is effacement of the fat at the right lateral recess and to a lesser degree left lateral recess at this level. It is crowding of the nerve roots within the thecal sac at this level. There is mild anterior subluxation of L4 and L5. Overall there is a moderate degree of spinal stenosis at this level. Compared to the previous exam there is some mild progression of the spinal stenosis but no substantial change. There is associated contrast enhancement at the endplates at this level. This appears to be new compared to the prior exam.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is a slight amount of anterior subluxation of L3 on L4 at this level. There is narrowing of the neural foramina at this level, however, the fat surrounding the exiting nerve roots within the neural foramina is preserved. There is a little bit more central disc protruding into the spinal canal at this level but otherwise there is no significant change compared to the prior exam.At L2-3 there is no significant compromise to spinal canal. There is a diffuse disc bulge present at this level, loss of disc space height and disc desiccation associated with the a left lateral disc protrusion with encroachment of the left-sided exiting nerve roots within the neural foramen. This has progressed compared to the prior exam. Endplate reactive changes are present which have high signal on T2-weighted imaging. This is also relatively new compared to prior exam. There are associated contrast enhancement at the endplates.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.
1.There are multilevel degenerative changes present in the lumbar spine and there is associated status post spinal surgery who is postoperative changes have evolved since the prior exam.2.Since the prior exam the patient has progressed a left far lateral disc protrusion at L2-3 which now encroaches on the left-sided exiting nerve roots within the neural foramen. There is associated with subacute endplate reactive change.3.There is redemonstration of moderate spinal stenosis at L4-5 associated with the encroachment of the right-sided exiting nerve roots within the neural foramina at this level. This is progressed very little since the prior exam.4.Some encroachment of the nerve roots at the lateral recess bilaterally at L3-4 is also stable, however, there is a superimposed central disc protrusion present.5.There is a subacute endplate reactive change present at L4-5 predominantly on the right side.