Worsening back pain. There is multilevel degenerative spondylosis. At L1 through L3, there is minimal disc bulging without significant spinal canal stenosis and perhaps minimal neural foraminal narrowing. However, at L3-4, there is left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy, which impinges upon the exiting nerve roots. There is also at least mild right neural foraminal narrowing at L3-4. At L4-5, there is bilateral facet hypertrophy and ligamentum flavum hypertrophy, as well as a disc bulge, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At L5-S1, there is disc bulging and bilateralfacet and ligamentum flavum hypertrophy with mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The spinal cord displays normal signal and morphology. However, there is persistent clumping of the right cauda equina nerve roots at the L5 level. There is an unchanged high T1 signal focus within S1, which likely represents a hemangioma. The paravertebral soft tissues are unremarkable.
1. Multilevel degenerative spondylosis. In particular, a left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy impinges upon the exiting nerve roots at L3-4 and disc bulging and bilateral facet and ligamentum flavum hypertrophy results in mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis at L5-S1. 2. Persistent clumping of the right cauda equina nerve roots at the L5 level may represent arachnoiditis.