HClinical history: 62 Year old female with lumbar back pain radiating into the left leg. Previous back surgery in 2001. Comparison was made with previous MRI of 08/4/2015.

MRI LUMBAR SPINE: PRE AND POST CONTRAST
Five lumbar type vertebrae. Last mobile segment labelled as L5/S1 as previous.
There is evidence of previous posterior fusion of L4 to L5 with bilateral uncomplicated pedicular screws and paraspinal bars .Intertransverse process fusion appear solid and uncomplicated.Decompressive laminectomies at L4/5 level with removal of the posterior elements. The thecal sac herniates into this posterior defect unchanged in comparison with previous.
The distal cord is normal. The conus medullaris terminates posterior to the L1 vertebral body.
Multilevel advanced degenerative disc disease affecting all lumbar levels with complete disc height loss at L4/5 and L5/S1 levels. Disc space narrowing also present at the other lumbar levels with associated broad based Schmorl nodules. Modic type II endplate changes surrounding the L4/5 disc.
No focal bony lesions or aggressive marrow infiltration.
Degenerative scoliosis convex to the left remain stable.
Multilevel facet joint and ligamentum flava hypertrophy with moderate spinal stenosis at L3/4 level. This is unchanged in comparison with previous though.
L1/2:
Circumferential disc bulge but no neural foraminal or lateral recess encroachment.
L2/3:
Central, paracentral and right foraminal mild disc protrusion. No neural foraminal or lateral recess encroachment though.
L3/4:
Bilateral posterior osteophytes with facet joint hypertrophy causes bilateral neural foraminal encroachment with left side worst affected. No fat signal seen surrounding the exiting L3 nerve root on the left and the left L3 nerve root appear to be compressed. Imaging features are stable here though in comparison with previous.
Lateral recesses are only mildly encroached with the L4 nerve roots contacted only.
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MR037931

Moderate spinal stenosis remain stable and CSF is still seen surrounding the nerve roots of the cauda equina.
Small joint effusion present in the left facet joint.
L4/5:
Previous surgery as described. There is far lateral disc protrusion. This does not contact the exiting L4 nerve root though.
Lateral recesses are patent.
No significant epidural fibrosis or arachnoiditis.
L5/S1:
Post surgical changes as described. The neural foramina and lateral recesses are widely patent. No significant epidural fibrosis.

COMMENT
Imaging features are stable in comparison with previous. Uncomplicated previous fusion of L4 to L5.
Moderate spinal stenosis present at L3/4 level. This is stable in comparison with previous and the lateral recesses are not significantly encroached.
At L3/4 there is neural foraminal encroachment on the left with compression of the exiting L3 nerve root. This appears stable in comparison with previous though.

MRI PELVIS: LIMITED STIR CORONAL
Proximal femurs appear normal with no evidence of AVN.
Moderate degenerative changes present in both hip joints.
The SI joints show degenerative changes in the inferior thirds with a geode present lateral to the inferior third of the left SI joint. No evidence of sacroiliitis.
Rest of the pelvic ring is normal with no focal lesions. The pelvic content appear grossly normal.
No pathology seen associated with the greater muscular attachments to the pelvis.
COMMENT
No acute pelvic pathology.