Female, 54 years old, status post L5-S1 laminectomy and lumbar fusion with increasing pain in the bilateral lower extremities. Assess for hematoma. Findings are seen compatible with recent posterior instrumented fusion of L5 and S1. A right hemilaminectomy has been performed at L5-S1 as well as interbody fusion. Extensive paraspinal soft tissue enhancement is seen within the posterior operative soft tissues, within expected limits. The spinal canal is not well seen in the operative region on postcontrast images due to metallic artifact. Where evaluable, the dorsal dura is uniformly thickened, likely reactive to recent surgery. A fluid collection measuring up to 34 mm in diameter is evident within the posterior subcutaneous soft tissues.Beginning at the L3-4 level and continuing down to the sacrum, a sizable collection is evident predominantly within the left dorsal epidural space which is T2 hyperintense and predominantly T1 hypointense. This collection effaces the thecal sac through its length, causing its most significant stenosis at the L5 level where the cauda equina nerve roots are displaced and compressed into the right aspect of the spinal canal.A severe scoliotic curvature of the lumbar spine is seen with a slight right lateral translation of L3 relative to L4. In the sagittal plane, there is a grade 1 anterolisthesis of L5 relative to S1. Apart from scoliotic deformities and surgical change, vertebral body morphology is grossly unremarkable. No worrisome marrow replacement is seen. The distal spinal cord and conus are unremarkable.L1-2: Left facet hypertrophy. Loss of disc height and disc osteophyte formation, particularly towards the left. No significant generalized canal stenosis. Moderate left foraminal narrowing. L2-3: Minimal lateral disc bulging. Questionable right lateral epidural effacement but no significant generalized canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Left dorsal epidural collection as above. Mild disc bulging asymmetric to the left with annular fissuring centrally. Moderate generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy. Large epidural collection as above. Significant generalized spinal canal stenosis with the nerve roots of the cauda equina displaced and compressed into the right lateral spinal canal. Moderate right foraminal narrowing. L5-S1: Spondylolisthesis with disc uncovering and disc bulging. Large epidural collection as above causing significant effacement of the thecal sac. The neural foramen are not well assessed due to metallic artifact.
1.Postoperative findings compatible with posterior instrumented fusion, right hemilaminectomy/facetectomy, and interbody fusion at L5-S1.2.Beginning at the L3-4 level and continuing down into the sacrum, there is a large predominantly left dorsal epidural collection which causes significant effacement of the thecal sac, particularly at L5 where the nerve roots of the cauda equina are displaced to the right aspect of the spinal canal and likely compressed. This collection could represent a hematoma or perhaps less likely a pseudomeningocele. An infected collection is not entirely excluded though this would be unlikely given the short time course from surgery. Discussed with Dr. Creighton at 4:00 PM on 12/14/15.3.Severe scoliotic deformity and superimposed degenerative findings are also noted as detailed above.