Clinical question: Status post lumbar decompression with fusion. Assess for spine stability and assess for postop bleeding. Signs and symptoms: Back pain. Nonenhanced CT of lumbar spine:Routine non-infused axial 3-mm CT images of the entire lumbar spine were obtained. Sagittal and coronal 2-D reformatted images were also acquired.Examination again demonstrates with no interval change extensive patchy sclerotic changes of the L5 vertebral body which extends into the bilateral pedicles.There is also evidence of mild compression fracture of L5 with slight bulge into the spinal canal similar to prior study.There is evidence of interval bilateral laminectomies at this level for spinal decompression. There is a drainage catheter extending from the canal at this level on the left (likely within the left epidural space) extending posteriorly and exiting the canal on the right side of the spinous process of L4.The alignment of vertebral column is similar to prior study an unremarkable.There is evidence of posterior fusion with placement of fixating rods extending from L4 to S1 and bilateral transpedicular screw placement in L4 and S1. There is no evidence of any detectable hardware abnormalities. There is extensive soft tissue thickening and and soft tissue emphysema posterior to the spinal canal in the soft tissues of lower back which appears to be within the expected range of. Findings. There is no detectable perispinal or prevertebral soft tissue abnormality or hemorrhage. Soft tissue densities there is thickening of the epidural space at the L4 level and suspected central spinal stenosis of approximately 6.5 mm. Follow-up with an MRI examination is recommended.
1.Stable patchy sclerotic changes of L4 vertebrae which extends into bilateral pedicles. There is also mild compression fracture of L4 similar to prior study. No appreciable interval change since prior study. Findings is suspected for a metastatic focus.2.Interval bilateral laminectomies at L4 vertebrae for decompression of the spinal canal. There is thickening of the lateral epidural spaces at L4 level contiguous with extensive increased soft tissue density posterior to the laminectomy site. This finding results in suspected central spinal stenosis at this level. Recommend further follow-up with an MRI to exclude hemorrhage.3.The alignment of vertebral column is unremarkable and stable since prior study.4.Postoperative changes of posterior fusion and bilateral transpedicular screw placement at L4 and S1 levels. No hardware abnormality.5.A drainage catheter extends from the right lateral epidural space at the L4 level posteriorly and exits the spinal canal as described above.