Reason: eval for post-op hematoma History: bilateral lower extremity pain Postsurgical changes of L4-L5 bilateral laminectomy with placement of bone graft material and an interspinous clamp. There is minimal anterolisthesis at L4-L5, otherwise alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with degenerative disc disease, most severe at L4-L5. Endplate degenerative changes at L4-L5. Normal signal within the distal cord and conus which ends at L1-L2. Clumping of the cauda equina below L2-L3 likely reflects arachnoiditis.There is a heterogeneous T2 hyperintense lesion within the spinal canal which extends from the L4-L5 level to the mid S1 level in the midline and along the right aspect of the thecal sac. There is moderate narrowing of the spinal canal. Finding is suspected to represent an epidural hematoma and measures approximately 1 cm in thickness and 4.3 cm in the craniocaudal dimension (best seen on sagittal T2 image 12/23). More superiorly, there are minimal extra-axial (possibly subdural) fluid/blood products are seen extending more superiorly along the right lateral aspect the thecal sac to the L2-L3 level without mass effect.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: Diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L4-L5: Laminectomy and medial facetectomies are noted at this level. Extrathecal fluid is noted at the level of the facetectomies. There is moderate to severe right-sided neural foraminal stenosis within the impingement of the right L4 nerve root. There is also mild left neural foraminal narrowing. There is a fluid collection which extends from the L4-L5 level inferiorly in the right aspect of the thecal sac extending to the L5-S1 level with moderate thecal sac narrowing.L5-S1: Mild disc bulge and facet arthropathy. Heterogeneous T2 hyperintense collection is seen in the right lateral aspect of the thecal sac with mild to moderate stenosis. There is no significant right neural foraminal narrowing. There is minimal left neural foraminal narrowingNumerous bilateral renal cysts.
1. Postsurgical changes of L4-L5 laminectomy and interspinous fusion. There is a heterogeneous T2 hyperintense lesion within the spinal canal which extends from the L4-L5 level to the mid S1 level along the right dorsal aspect of the thecal sac. There is moderate narrowing of the spinal canal. Finding is suspected to represent an epidural hematoma and measures approximately 1 cm in thickness and 4.3 cm in the craniocaudal dimension (best seen on sagittal T2 image 12/23).2. Clumping of the cauda equina nerve roots below L2-L3 compatible with arachnoiditis.3. Moderate to severe narrowing of the right L4-L5 neural foramen which may be impinging the right L4 nerve root.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.