Male, 60 years old, with low right-sided back pain, getting worse over the past one year. Minimal anterolisthesis of L3 relative to L4 is seen without change. Spinal alignment is otherwise anatomic. Mild chronic wedging of the anterior aspect of the T11 vertebral body is again seen. Vertebral body heights are otherwise within normal limits. No evidence of marrow replacement is observed. Mild edema is evident centered on the L4-5 facet complexes, similar to prior. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. Disorganization of the cauda equina nerve roots is seen likely secondary to spinal canal stenosis at the L3-4 level.T11-12: Facet arthropathy and disc bulging. No significant spinal canal or foraminal stenosis.T12-L1: Mild disc bulging. A superimposed left paracentral disc extrusion is new. Mild generalized spinal canal narrowing with effacement of the left ventral thecal sac, new from prior. No significant foraminal narrowing.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Ligamentum flavum thickening. Mild disc bulging with a superimposed left foraminal and far lateral protrusion, unchanged. No significant generalized spinal canal stenosis. Mild left foraminal narrowing, unchanged. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulge. Severe generalized spinal canal stenosis with effacement of CSF and crowding/impingement of the nerve roots of the cauda equina, unchanged. Mild lateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a superimposed left foraminal and far lateral protrusion which has increased in size. Moderate generalized spinal canal stenosis, particularly affecting the left lateral recess. Moderate left foraminal narrowing, unchanged. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.
1.Severe spinal canal stenosis at L3-4, caused by a combination of posterior element hypertrophy and disc bulging, has not significantly changed.2.A left paracentral disc extrusion at T12-L1 is new, though it causes only mild effacement of the thecal sac. A left foraminal/far lateral protrusion at L4-5 has also increased in size though the resulting left foraminal stenosis is unchanged.