Diagnosis: Spinal stenosis, lumbar region, with neurogenic claudicationClinical question: spinal stenosisSigns and Symptoms: pain and weakness 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 a levocurvature to the lumbar spine. There is left lateral translation of L4 on L5 and right lateral translation of L2 on L3. In addition the right side of the endplates at the L3-4 disc space abut each other.On T2 STIR imaging there is high vertebral body signal adjacent to the L4-5 endplates. On the prior exam similar finding was present at L2-3 and L5-S1.At L5-S1 there is no significant compromise to spinal canal. There is some left lateral translation of L5 on S1. There is loss of disc space height, endplate reactive change, diffuse disc bulge and facet hypertrophy at this level which results in effacement of the fat within the neural foramina bilaterally and encroachment of the exiting nerve roots with foramina bilaterally. There is fluid in the right facet joint at this level. Compared to the prior exam this has not changed substantially.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with facet hypertrophy bilaterally but worse on the right compared to the left. There is left lateral translation of L4 on L5 There is some mild triangulation of the thecal sac. There is ligamentum flavum hypertrophy at this level. There is encroachment of the right-sided exiting nerve roots at this level as a result of facet hypertrophy and disc bulge. Overall there is a mild degree of spinal stenosis present at this level. There is also some mild encroachment of the nerve roots at the right lateral recess at this level. Compared to the prior exam this has not changed substantially.At L3-4 there is no significant compromise to spinal canal or neural foramina. The right aspect of the endplates at this level abut each other. There is some facet and ligamentum flavum hypertrophy present at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is right lateral translation of L2 on L3 present. There is mild narrowing of the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is a levocurvature of the lumbar spine present associated with multilevel degenerative changes as detailed above with encroachment of the exiting nerve roots bilaterally at L5-S1 and on the right side at L4-5. There is also some encroachment of the nerve roots of the right lateral recess at L4-5.2.Since the prior exam findings suggest that there is greater subacute inflammatory change on the current exam at L4-5 on the present study whereas this was previously the case at other levels on the prior exam.