Female, 83 years old, with lateral left lower extremity numbness and tingling after spinal drain placement. Assess for spinal cord ischemia, abscess or hematoma. Thoracic:The thoracic kyphosis is exaggerated. Alignment is otherwise unremarkable. Degenerative endplate signal abnormality and enhancement is evident scattered at several levels, but no worrisome narrow replacement is detected.The spinal cord demonstrate normal signal intensity and morphology. No evidence of pathologic intraspinal enhancement is seen.Mild facet hypertrophy develops at lower thoracic levels. In addition, disk bulging is seen at T10-11 and T11-12. No significant spinal canal or neuroforaminal stenosis is suspected.Partially visualized is a large descending aortic aneurysm status post endovascular repair.Lumbar:A trace anterolisthesis of L4 relative to L5 is seen. Spinal alignment is otherwise unremarkable. Vertebral body height morphology are normal allowing for endplate degenerative abnormalities most significantly affecting L5-S1. No evidence of concerning marrow replacement or enhancement is seen.The visualized conus and cauda equina are within normal limits. No intrathecal enhancement is observed. The reported spinal catheter is not presently visualized and has likely been removed. Mild thickening and subtle enhancement of the ligamentum flavum on the right at L2-3 is nonspecific but could reflect the prior site of catheter placement. It may also be related to facet degeneration as the lumbar facets become progressively hypertrophic at lower levels and do show evidence of mild edema and inflammatory enhancement.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant spinal canal or foraminal stenosis.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild narrowing of the subarticular aspects of the spinal canal. No significant generalized canal stenosis or cauda equina impingement. Mild bilateral foraminal narrowing. L2-3: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild narrowing of the subarticular aspects of the spinal canal. Mild generalized spinal canal stenosis but without cauda equina impingement. Moderate right and mild left foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal narrowing which particularly affects the right lateral recess. A perineural root sleeve cyst is seen in the right foramen. Mild bilateral foraminal narrowing.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis. Mild right foraminal narrowing.L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk asymmetric towards the left foraminal zone. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. Aneurysmal dilatation of the abdominal aorta is also partially visualized on this exam.
1.No specific findings identified in the thoracic spine to account for the patient's symptoms.2.Mild disk degeneration is seen through the lumbar region with more pronounced facet arthropathy, particularly at lower lumbar levels. These findings result in at most moderate spinal canal stenosis and moderate foraminal narrowing as discussed by level above.3.Thickening and mild enhancement of the ligamentum flavum on the right at L2-3 may reflect granulation from prior lumbar catheter placement, if indeed it had been placed at this level. It may also be related to facet arthropathy. In any event, no evidence of epidural or paraspinal abscess is seen.4.Thoracic and abdominal aortic aneurysms are partially visualized on this examination.