Status post L4 intradural mass resection, prelim pathology of schwannoma, evaluate extent of resection. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild endplate irregularity involving the superior L5 and inferior L4 endplates which is on a degenerative basis. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.There are postsurgical changes of laminectomy at the L4-L5 level for resection of intradural mass which demonstrated partial cystic and enhancing solid components. There is no definite evidence of residual tumor. There is enhancement involving the L4-L5 level along the dura and epidural space compatible with postoperative change. There is a postoperative fluid collection in the laminectomy bed including blood products which contributes to moderate to severe effacement of the thecal sac from the upper L4 to the lower L5 levels. There is clumping of the cauda equina nerve roots at these levels. There is a 5 mm focus of T1 hyperintensity involving the left lateral epidural space at the L4-5 level likely related to blood products.Multilevel degenerative changes are present including mild disc bulges at the L2-L3 to L5-S1 levels. There is a left paracentral disc extrusion at the L4-L5 level with mild inferior migration. There is mild bilateral L4-L5 and L3-L4 neural foraminal stenosis. No high-grade neural foraminal stenosis is present. Spinal canal at L3-L4 and more superiorly is preserved. There is also mild multilevel facet arthropathy, relatively worse at the L4-L5 level.There are small bilateral renal cysts.
1. Postoperative changes related to resection of previously seen cystic and solid mass at the L4 to L5 levels. There is no definite evidence of residual tumor.2. Moderate to severe effacement of the thecal sac at the upper L4 to lower L5 levels with clumping of the cauda equina nerve roots, which may reflect combination arachnoiditis and extrinsic compression from postoperative fluid collection in the laminectomy bed. Bony spinal canal is surgically decompressed at this level.3. Mild degenerative changes as above including a disc extrusion at the L4-L5 level.