Clinical question: Worsening back pain and lower extremity radiculopathy. Signs and symptoms: Same. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate moderate bilateral ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild to moderate bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise or interval change.L4 -- L5 demonstrate bilateral transpedicular screw placement since prior exam. Mild to moderate disk disease and loss of disk height with mild interval progression. There is evidence of laminectomy with resultant expansion of thecal sac and no spinal stenosis or neural foraminal compromise. Tiny focus of T2 increase signal intensity within the annulus of the disk suspected of an annular fissure.L5 -- S1 demonstrate metallic hardware artifact posteriorly from prior fusion. There is moderate disk disease and loss of disk height with interval progression since prior exam. There is however no spinal stenosis or neural foraminal compromise. Bilateral transpedicular screws at S1 level is also noted.
1.Interval post operative changes of laminectomy at L4 -- L5 level, posterior fixating wires and bilateral transpedicular screws at L4 and S1 levels as detailed.2.Mild progression of degenerative disk disease at L4 -- 5 and L5 -- S1 levels and a tiny annular fissure at L4-L5 level.3.No spinal stenosis or neural foraminal compromise at any level.