Findings:
Vertebral bodies: There is normal vertebral body height, alignment and marrow signal in the lumbar
spine. No paraspinous mass or fluid collection demonstrated.
Intervertebral disks: Prominent disk space narrowing and desiccation at L1-2, L2-3 and L3-4 noted.
Lesser amount similar changes L4-5 and L5-S1 present.
Conus:The conus medullaris is normally positioned. No significant anterior or posterior
extradural impression on thecal space identified. No paraspinous mass or fluid collection evident.

Axial imaging at T12-L1 -- facet arthropathy no canal stenosis or disk extrusion.

Axial imaging at L1-2 -- posterior disk/osteophyte complex with right paracentral disk protrusion
which effaces the right lateral recess. Central canal is mildly stenotic at 8 mm in AP dimension
with right >left lateral recess effacement. Caudal neuroforaminal narrowing bilaterally appears to
produce bilateral L1 nerve root entrapment.

Axial imaging at L2-3 -- central canal stenosis to 8 mm paired moderate facet arthropathy with
ligamentum flavum hypertrophy present. Bilateral neuroforaminal narrowing present, right >left.
Bilateral L. nerve root entrapment suspected, more pronounced on the right than left. Posterior
disk/osteophyte complex appears to be associated with a broad based disk bulge.

Axial imaging at L3-4 -- severe canal stenosis present on the previous study appears to worsened.
Complete or near complete effacement of CSF from a round the nerve roots. Central canal measures 5
-- 6 mm in size. Moderately severe facet arthropathy and ligamentum flavum hypertrophy associated
with a broad based disk bulge with central disk extrusion. Small amount of cranial migration of
disk material. Thecal space has a trefoil appearance. Caudal neuroforaminal narrowing bilaterally
with bilateral L3 nerve root entrapment present.

Axial imaging at L4-5 -- central canal stenosis to 5 mm appears unchanged. A component of
epidural lipomatosis associated with broad-based disk osteophyte complex which effaces the CSF in
the anterior thecal space. No extruded disk fragment. Bilateral neuroforaminal narrowing appears
to produce bilateral L4 nerve root entrapment. Changes are stable from 2011.

Axial imaging at L5-S1 -- diffuse disk bulge. Borderline canal size. No extruded disk fragment,
canal stenosis or neuroforaminal narrowing.

Impression:
1. Multilevel central canal stenosis as detailed above. Multilevel neuroforaminal narrowing with
multilevel nerve root entrapment as detailed above.

2. Central canal stenosis appears to worsened slightly at L3-4 from prior. Significant central
canal stenosis at L3-4 and L4-5 again noted. Lesser amount of canal stenosis at L1-2 and L2-3.