New right L5 radiculopathy, assess S1 screw. Right lower extremity weakness and pain. Five lumbar type vertebral bodies are again presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper to mid L2 level. There is fibrofatty infiltration of the filum terminale, measuring less than 2 mm in thickness.Again seen are postoperative changes of L5-S1 interbody fusion via left transforaminal approach. Left L5-S1 facetectomy with foraminal decompression again seen. Hardware appears in grossly unchanged position and was better assessed on recent CT from 7/11/2016. No foraminal or extraforaminal nerve root impingement is seen associated with the S1 screw as questioned. There is mild edema involving the L5-S1 disc space which may be on a postoperative basis. No surrounding inflammatory changes or fluid collections are seen to suggest infection.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with small central protrusion. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with small right central protrusion. No spinal canal or neural foraminal stenosis.L5-S1: Postoperative changes as described above. Spinal canal is decompressed. Left neural foramen is also surgically decompressed. There is enhancing scar tissue involving the left neural foramen without significant nerve root impingement within the limits of susceptibility artifact. There is mild to moderate right-sided neural foraminal stenosis with disc height loss and eccentric rightward disc bulge with calcification and endplate osteophyte, which are better seen on recent CT.
1. Postoperative changes of L5-S1 fusion again seen. Hardware was better assessed on recent CT, but there is no nerve root impingement associated with the S1 screw as questioned. There is mild to moderate degree of right-sided L5-S1 neural foraminal stenosis on a chronic degenerative basis related to partial calcified disc bulge and endplate osteophyte. Remainder of the neural foramina are patent.2. Fibrofatty infiltration of the filum terminale incidentally noted, with normal conus position.