Low back pain, right leg pain. History of discectomy in December Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. Mild bilateral neural foraminal narrowing. No spinal canal stenosis. Mild facet arthropathy.L4-L5: Status post right-sided laminectomy and discectomy. Diffuse disc bulge, facet arthropathy, and ligamentum flavum thickening are seen on the current study with at least moderate spinal canal stenosis. Mild clumping of the cauda equina nerve roots is also noted compatible with arachnoiditis. There is mild to moderate bilateral neural foraminal narrowing which appears worse since prior. Postcontrast images demonstrate enhancement along the dorsal aspect of the disc bulge compatible with granulation tissue as well as enhancing tissue involving the right epidural space and paraspinous soft tissues also compatible with granulation tissue. No recurrent disc protrusion or extrusion is evident. There is effacement of the lateral recesses.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues demonstrate postsurgical changes without significant fluid collections and otherwise unremarkable.
Interval postsurgical changes of right L4-L5 laminotomy and discectomy are seen. No (focal) recurrent disc herniation is evident. However, there is residual diffuse disc bulge with granulation tissue, facet arthropathy, and ligamentum flavum thickening which in combination result in at least moderate degree of spinal canal stenosis. There is also mild to moderate neural foraminal stenosis at L4-L5 which appears slightly worse than prior.There is mild clumping of the cauda equina nerve roots suggestive of mild arachnoiditis. 