Low back pain with radiation into the legs. History of epidural injections. There has been prior posterior fixation between L4 and L5 using screws and posterior rods, as well as interbody fusion. There is minimal anterior subluxation at L4-L5 as well as C2-C3. There is straightening of the cervical vertebrae, but no spondylolisthesis. The vertebral bodies heights are preserved. The spinal cord is not compressed and shows no definite signal abnormality. The tip of the conus medullaris lies at the upper L1 level. At the L2-3 and L3-L4 levels, there are disc bulges, facet hypertrophy, and ligamenta flava thickening, which appear to indent the cauda equina nerve roots. There is also neural foraminal stenosis bilaterally at the L2 through L5 neural foramina, perhaps most pronounced at the left L3-4 level. Multilevel cervical and thoracic disc-osteophyte complexes result in slight ventral indentation of the thecal sac, but no spinal cord compression. There is atrophy of the lower paraspinal muscles. There is an incompletely imaged, well-circumscribed, homogeneously T1-hypointense and T2-hyperintense left paraspinal mass at the T4 and T5 levels, which measures up to 3.8 cm craniocaudally. This is associated with remodeling of the vertebral bodies, but does not impinge on the spinal canal or neural foramina. A large, presumably cystic mass in the abdomen measures up to 15 cm craniocaudally. A smaller, perhaps also cystic lesion is present in the left side of the pelvis, measuring up to 4.1 cm.
1.Prior fusion at L4-L5 and degenerative disease at L2-3 and L3-L4, resulting in spinal canal and bilateral neural foraminal stenosis. 2.Multilevel degenerative spondylosis in the cervical and thoracic spine is not associated with spinal cord compression.3.A left upper thoracic paraspinal lesion may represent a developmental cyst or neoplasm. However, assessment is limited by the lack of intravenous contrast. 4.Large presumably cystic abdominal mass and presumably cystic pelvic lesions may represent renal and adnexal cysts or neoplasms, respectively. However, assessment is limited by the lack of intravenous contrast. These can be further assessed by renal and pelvic ultrasound or abdominopelvic CT, if clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.