Clinical question: Chronic back pain, history of multiple lumbar surgeries, meningitis. Evaluate for abnormality, infectious process, scarring. Signs and symptoms: Chronic LBP and left leg pain. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is unremarkable signal intensity of vertebral common.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and unremarkable otherwise.L3 -- L4 demonstrate minimal ligamentum flavum hypertrophy and unremarkable otherwise.L4 -- L5 demonstrate a mild to moderate disk disease and loss of disk height. There is evidence of prior surgery however without evidence of spinal stenosis. Mild left neural foraminal compromise and patent right. There is a thin linear T2 hyperintensity in the midline and to the left suggestive of an annular fissure with expected enhancement.L5 -- S1 demonstrate moderate disk disease and loss of disk height, broad-based central and left port disk protrusion with resultant compromise of the left lateral recess. No central spinal stenosis. Mild left neural foraminal compromise. There is evidence of left sided surgery/laminotomy with epidural thickening and enhancement on the left lateral aspect of thecal sac which is inseparable from the left S1 nerve root consistent with epidural scarring.There is thickening and abnormal angulation of cauda equina at L4 and L4 -- L5 disk level suggestive of arachnoiditis.
1.At L4 -- L5 there is evidence of prior surgery with resultant expansion of thecal sac and no evidence of central spinal stenosis. Mild left neural foraminal compromise is detected. Annular fissure with expected enhancement on the left is noted. 2.At L5 -- S1 there is evidence of surgery on the left with epidural thickening/scarring and enhancement which is inseparable from the left S1 nerve root as detailed. No spinal stenosis however mild left neural foraminal compromise is present. Broad-based disk protrusion in the midline and to the left with resultant left lateral recess compromise.3.There is partial clumping of cauda equina with abnormal angulation at L4 and L5 levels highly suggestive of arachnoiditis.