68 years Female (DOB:4/18/1948)Reason: severe back pain, AMS - h/o recent s/p L3-4, L4-5 XLIF on 7/25 History: As aboveReferring Attending: DRAGANA D RADOVANOVIC The conus medullaris on sagittal imaging is grossly intact. 5 lumbar type vertebral bodies are presumed to be present. The patient is status post posterior fusion using pedicle screws and interconnecting rods at the L3, L4 and L5. Patient's also status post anterior instrumentation at L3-4 and L4-5 disc spacers.The prior exam ring-enhancing lesions in the psoas muscles bilaterally have decreased in size. Axial measurements of enhancing lesions in the current exam on the right psoas are 20 x 9 mm and on the prior exam 26 x 14 mm on the left psoas muscle and measures approximately 20 x 17 mm and previously measured 5 x 32 mm.Since the prior examination subcutaneous fluid collections have also decreased. One in the left side at the C4 level measures 14 x 8 mm in the current exam and the 21 x 10 mm on the prior.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is facet moderate hypertrophy present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Ring-enhancing lesions suspicious for infection in the psoas muscles and subcutaneous tissues have decreased in size since the prior exam but have not resolved. Please note the patient's metal artifact from instrumentation may obscure abnormalities adjacent to these devices.2.Status post anterior and posterior instrumentation for fusion.3.Degenerative changes are present in the lower lumbar spine.