73-year-old male patient with inability to walk on left leg with worsening exam and in the ED. Question of an epidural bleed. Interval postsurgical changes of a right laminectomy/facetectomy of L3, and laminectomy of L4. There are 2.2 x 1.3 cm and 1.7 x 1.6 cm T2 hyperintense and T1 hypointense collections at these levels, respectively, within the surgical bed, which extend into the epidural space and partially efface the thecal sac. However, the extent of effacement is similar to overall slightly improved from the presurgical study. These collections are compatible with postoperative fluid. No epidural hematoma is identified.The lumbar spine is in normal alignment, with continued straightening of the normal lumbar lordosis. There is mild disc narrowing at L4-L5 with disc desiccation at this level as well as at L1-L2 to L3-L4. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles predominantly although there also remains prominence of dorsal epidural fat along the upper lumbar spine. There is redundancy of the cauda equina nerve roots which are also thickened, due to the spinal stenosis detailed below. At T12-L1, there is no significant disc pathology or stenosis.At L1-L2, there is a trace disc bulge and minimal facet arthropathy and ligamentum flavum thickening. There is mild-moderate central spinal canal stenosis.At L2-L3, there is a stable trace disc bulge with slight left paracentral prominence. There is moderate bilateral facet arthropathy and ligamentum flavum thickening with overall mild to moderate central spinal canal stenosis.At L3-L4, there are post-surgical changes of a right laminectomy/facetectomy with fluid within the surgical bed as described above. There is trace disc bulge with left facet arthropathy. There is moderate-severe central spinal canal stenosis as well as narrowing of the lateral recesses. There is mild-moderate right foraminal narrowing and mild stenosis on the left.At L4-L5, there are post-surgical changes of a right laminectomy with fluid within the surgical bed as described above. There is a disc bulge with right-sided prominence. There is moderate-severe left facet arthropathy. There is severe central spinal canal stenosis as well as near complete effacement of the lateral recesses. There is mild to moderate left and moderate right foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis.
1. Post-surgical changes of right laminectomies/facetectomies of L3 and L4 with post-operative fluid in the surgical bed and similar to slightly improved central canal stenosis at the levels, although remaining high-grade. No evidence of an epidural hematoma.2. Developmentally narrow lumbar spinal canal with otherwise stable spondylotic changes at the other spinal levels. 