Recent L4-L5 fusion with radicular pain and bowel incontinence. Five lumbar type vertebral bodies are presumed to be present. There are postsurgical changes related to recent extension of spinal fusion with hardware now extending from the L4 to the S1 levels. Hardware is better assessed on recent CT and includes bilateral paraspinous rods and pedicle screws at L5 and S1 as well as a unilateral right pedicle screw at the L4 level. There is high T2 signal within the L4-L5 disc space related to recent interbody implant placement. There is also edema involving the L4 and L5 vertebral bodies which is also nonspecific in this postoperative period.Vertebral body heights in the lumbar spine are normal. There is loss of lumbar lordosis as seen before. Alignment is otherwise grossly maintained. There is moderate to severe thecal sac effacement at the L4-L5 level related to fluid in the dorsal epidural space with intermediate T1 signal and T2 hyperintensity indicating at least some blood products. Large right-sided laminectomy defect and facetectomy at this level are better seen on recent CT.There is mild to moderate spinal canal stenosis at the L3-L4 level related to disc bulge with small dorsal annular fissure, ligamentum flavum thickening, and facet arthropathy. Spinal canal in the lumbar spine is otherwise patent. Right L4-L5 neural foramen is surgically decompressed. There is fairly mild multilevel neural foraminal narrowing in the remainder of the lumbar spine as seen previously but suboptimally evaluated due to artifact at the level of the pedicle screws.There is also a hematoma/fluid collection in the subcutaneous soft tissues from the L4 to S1 levels on the right with T1 shortening.
1. Recent postsurgical changes related to extension of spinal fusion which now extends from L4 to S1. There is moderate to severe thecal sac effacement at the L4-5 level related to postoperative epidural fluid and blood products. The bony spinal canal is surgically decompressed at this level.2. Subcutaneous postoperative hematoma/fluid collection at the right L4 to S1 levels.3. Mild to moderate spinal canal stenosis at the L3-L4 level which is unchanged and on a chronic degenerative basis.