Female, 51 years old, with epidural abscess status post debridement. Thoracic:Evidence of laminectomy is seen on one side or the other at most levels in the thoracic spine. The posterior operative soft tissues are edematous and tracking fluid is evident through the subcutaneous surgical plane most notably in the lower cervical and upper thoracic regions.On comparison with the preoperative examination, the extensive ventral epidural collection has significantly decreased in size. In most areas the collection has completely or nearly completely resolved. There is no longer any significant thecal sac encroachment or displacement of the spinal cord. No cord signal abnormality is detected.A deep concavity of the T12 superior endplate is unchanged. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic. No evidence of marrow replacement or marrow edema is seen. No significant compromise of the spinal canal or neural foramina is noted. Scattered mild areas of disc degeneration are seen.Lumbar:The previously seen posterior fusion instruments at L4-5 have been removed, though the intervertebral device remains in place at this level. The large left paraspinal fluid collection that had previously encompassed the fusion instruments has nearly completely resolved. There remains a very small collection of fluid spanning the left L4-5 laminectomy bed which measures approximately 3 cm in length and approximately 1 cm in width when measured in the axial plane. This collection does extend into the lateral and ventral epidural space at L4-5 where it continues to narrow the thecal sac, but the degree of narrowing has improved.Evidence of laminectomy is seen on the left at L2 and on the right at L1. The epidural collection seen previously throughout the lumbar spine has improved though a predominately ventral collection does persist from L1 down to L3 measuring up to 9 mm in thickness. The thecal sac is narrowed but to a much lesser degree than on the prior examination.Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate signal changes at L4-5 are again seen which may be postoperative in nature. No significant disc degeneration is detected. Apart from narrowing caused by epidural fluid, there is no additional superimposed spinal canal or foraminal stenosis.
Postoperative findings are seen compatible with removal of posterior fixation instruments at L4-5 and multilevel laminectomy for debridement of a large epidural abscess involving a majority of the spine. In the thoracic region, this epidural collection has completely or nearly completely resolved. In the lumbar spine, some residual epidural fluid persists, for example ventrally from L1 through L3. In addition, there remains a small fluid collection within the left laminectomy defect at L4-5 which extends into the lateral and ventral epidural space causing encroachment on the thecal sac. Both these areas of epidural fluid in the lumbar spine have significantly improved when compared to the preoperative examination.