Clinical question: Stenosis causing left flank pain? Signs and symptoms: Left flank pain. Unenhanced thoracic MRI:There is normal anatomical alignment of vertebral column.There is no the distal central spinal stenosis at any level.There is extensive expected post operative changes of posterior laminectomy and anterior fusion including placement of metallic fixating screws extending from T10 inferiorly to T2 level however without evidence of spinal stenosis or neural foraminal compromise. There is normal signal intensity and caliber all thoracic cord. The paraspinal soft tissues demonstrate no abnormalities.Nonenhanced MRI of lumbar spine:There is normal anatomical alignment of the vertebral column.There is no evidence of central spinal stenosis at any level.There is no evidence of neural foraminal compromise at any level. The visualization of the above described postoperative changes of posterior laminectomy and anterior fusion and placement of metallic hardware in the vertebral bodies extending from T10 inferiorly through L2 levels. The signal intensity and morphology the conus and the cauda equina demonstrate no abnormalities. There is mild degenerative changes of posterior elements at the L4 -- L5 and L5 -- S1 levels without appreciable significant degenerative disk disease. No spinal stenosis or neural foraminal compromise. A tiny linear focus of T2 increased signal intensity within the annulus of the disk on the right (axial T2 series 18 image 29 and sagittal T2 series 13 image 4) is consistent with a tiny annular fissure. There are no prior exams for comparison.There is a well-demarcated CSF signal intensity expansile lesion within the spinal canal at S2 level with associative mild bony remodeling consistent with a Tarlov cyst. Remote possibility of an arachnoid cannot be entirely excluded.
1.Nonenhanced MRI of thoracic and lumbar spine demonstrate expected extensive postoperative changes of posterior laminectomy and anterior fusion extending from T10 to L2 levels without spinal stenosis or neural foraminal compromise.2.Mild degenerative changes of posterior elements in the lower lumbar spine and a tiny a right far lateral L4 -- L5 annular fissure as detailed.3.Expansile CSF signal intensity finding within the spinal canal at S2 is believed to represent a Tarlov cyst.4.Essentially unremarkable nonenhanced examination otherwise.