CONCLUSION: x- rays
No dynamic instability between flexion and extension.
Slight increase in dural thecal sac deformity at L4-5 with extension as compared to flexion.
INTERPRETATION: Normal vertebral alignment. There is a ventral extradural deformity of the thecal sac at the L3-4 and L4-5 levels with decreased filling of the L5 nerve roots bilaterally right greater than left. Upper lumbar thecal sac is unremarkable. No evidence for arachnoiditis.
Mild concentric deformity the thecal sac at the L4-5 level with decreased filling of both L5 nerve roots right greater than left.
Please see CT scan post myelography for further detail analysis
INTERPRETATION: Comparison is made with MRI dated 11/18/2009. Normal posterior alignment with no spondylolisthesis. No evidence for compression fracture. No arachnoiditis. Small amount of the gas is seen along the epidural space from prior injection for contrast.
L5-S1: Prior right laminectomy. There is a shallow central and right paracentral disc bulge contacting the right S1 nerve root without significant compression. There is no central stenosis. Chronic right L5 pars defect along the low margin with hypertrophic right facet arthropathy. There is mild right foraminal narrowing without ganglionic impingement.
L4-5: There is broad-based 4 mm central contained disc herniation which does efface the ventral thecal sac and contacts both L5 nerve roots. No significant compression. There is overall mild to moderate central and subarticular recess narrowing. Mild facet ligamentum thickening but no articular degeneration. Mild bilateral foraminal narrowing without ganglionic compression.
L3-4: No disc herniation or nerve root impingement. Facet joints are unremarkable with patent neural foramen.
L2-3: No disc herniation or nerve root impingement. Foramina are patent with normal facet joints.
L1-2. Normal posterior disc margin with patent central canal, neural foramen and normal facet joints.
No abnormality involving the lower thoracic or conus medullaris region.
Postoperative changes on the right at L5-S1 with a shallow right paracentral disc bulge and S1 nerve root contact but no significant compression.
Broad-based contained central disc herniation L4-5 with mild to moderate central and subarticular recess stenosis and L5 nerve root contact without significant compression.
Foraminal narrowing is mild on the right at L5-S1 and bilaterally at L4-5.
Chronic right low L5 pars defect with moderate right facet arthropathy.
notsurewhat the next step is, any advice would be helpful