Clinical question: Status post fusion, evaluate for hematoma. Signs and symptoms: Back pain, left leg weakness. Nonenhanced thoracic MRI:Examination demonstrates normal anatomical alignment of vertebral column.The signal intensity of vertebral column demonstrate minimal changes secondary to degenerative disease and unremarkable otherwise.There is no detectable spinal canal compromise or stenosis and no evidence of epidural hemorrhage. There is no evidence of any significant neural foraminal compromise at any level.Signal intensity and caliber of thoracic cord remains beginning normal.Nonenhanced lumbar MRI:Examination is a status post posterior approach multilevel laminectomy and placement of fixating screws at L4 through S1 levels.Extensive increased T2 and decreased T1 signal intensity of paraspinal soft tissues consistent with edema and without detectable hematoma or any associated mass effect on the thecal sac is noted.There is no detectable epidural hemorrhage.There are no prior exams for comparison. There is a central and rightward disc extrusion at L5-S1 level (sagittal series images 7 and 8) which results in mass effect and posterior displacement of the thecal sac and mild central spinal stenosis. Although difficult to precisely assess due to metallic hardware artifact no convincing evidence of neural foraminal compromise.Examination also demonstrates an epidural defect on the left posteriorly and laterally at L5-S1 level (axial T2 series 8 images for an 5). The finding could represent degenerative changes from left articulating facet and possibility of a synovial cyst cannot be entirely excluded. The finding results in significant left lateral recess compromise. There are no prior exams for comparison however if such a studies are available and provided to the radiology department and an addendum to this report will be submitted after comparison.There is a ventral/left lateral T2 hypointense epidural defect at L4-L5 best appreciated on axial T2 series 8 on images 7 and 8 which demonstrated mass effect and posterior displacement of the thecal sac with resultant left lateral recess compromise. There is no convincing evidence of central spinal stenosis at this level. This finding is also well appreciated on sagittal T2 series 5 on images 9 through 11. Finding has the appearance of a large disc protrusion however possibility of a surgically placed prosthesis within the disc space cannot be excluded. If there are prior exams available and are provided to radiology department and addendum to this report will be submitted after comparison.
1.Nonenhanced MRI of the lumbar spine demonstrate extensive postoperative changes of posterior approach and fusion with placement of transpedicular screws at L4 through S1 as detailed. There is no evidence of epidural hemorrhage. There is a left-sided ventral epidural defect with resultant left lateral recess compromise which could represent a large disc protrusion, however possibility of postop change and including a surgically placed device within the disc space cannot be entirely excluded. At L5-S1 there is a large central and rightward disc extrusion which applies mass effect on the thecal sac with resultant mild central spinal stenosis as detailed.2.Unremarkable nonenhanced MRI of thoracic spine with the exception of mild degenerative changes as detailed.