Clinical question: Assess for hematoma, either compression of nerve roots, specifically at postoperative T12-L5. Signs and symptoms: L3, L4 and L5 weakness. Pre- and post enhanced lumbar MRI:Moderate dextroscoliosis of lumbar spine centered at L1-L2 level is noted. There is mild right lateral subluxation of L2 on L3 and L3 on L4 levels.T10-T11 demonstrate degenerative changes with mild central spinal stenosis and no significant neural foraminal compromise.T11-T12 demonstrate moderate disc disease without spinal stenosis or significant neural foraminal compromise.T12-L1 demonstrate moderate disc disease and without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate postoperative changes and including a disc space prostheses. No spinal stenosis however mild to moderate left lateral recess and left neural foraminal compromise secondary to scoliosis and asymmetric left-sided hypertrophic changes is noted. There is a tiny left lateral disc protrusion (axial T2 series 501 image 38 and sagittal T2 series 801 image 13) with resultant mild compression effect on the thecal sac is also noted.L2-L3 demonstrate advanced disc disease and significant loss of disc height, no spinal stenosis or neural foraminal compromise. Disc space prosthesis is identified.L3-L4 demonstrate moderate disc disease and loss of disc height, disc space prosthesis is present. There is mild asymmetric right-sided facet hypertrophic changes result in mild to moderate right neural foraminal compromise and no evidence of central spinal stenosis.L4-L5 demonstrate mild disc disease and mild facet and ligamentum flavum hypertrophy. There is a disc space prosthesis at this level. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild disc disease and degenerative changes of posterior elements without spinal stenosis or neural foraminal compromise.There is no evidence of epidural hemorrhage as is questioned clinically.There is mild increased T1 hyperintensity of the right psoas muscle suggestive of fatty infiltrate and possible atrophy. No evidence of spinal hemorrhage or mass effect. The visualized abdominal aorta demonstrate normal caliber and signal intensity.Post enhanced images demonstrate subtle expected enhancement of degenerative changes and including mild enhancement along the adjacent endplates to L1-L2 disc level.
1.Examination demonstrate no findings to account for patient's symptomatology.2.Postoperative changes and including disc space prostheses as detailed above and without evidence of complication.3.No evidence of central spinal stenosis at any level.4.Neural foraminal compromise secondary to degenerative changes and an alternating pattern related to scoliosis as detailed. 5.Expected enhancement of the degenerative changes and unremarkable post contrast images otherwise.