Diagnosis: Other mechanical complication of other internal orthopedic devices, implants and grafts, subsequent encounter. Other mechanical complication of other internal orthopedic devices, implants and grafts, subsequent encounter Five lumbar type vertebral bodies are presumed to be present. The patient was previously status post posterior laminectomies and posterior and anterior fusion at L4-5. The patient is status post more recent anterior fusion using disc spacers at multiple levels which include the lower thoracic and upper lumbar spine disk spaces. Anterior fusion levels visualized on this exam include the T11-T12, T12-L1 and L1-L2 . Since the prior exam additional pedicle screws have been placed at L1 and L2 bilaterally and the interconnecting rods have been extended from the lower thoracic region down to the L2 level.There is contrast enhancement at the vertebral bodies of L2, L1 and T12 and irregularity along the discs at L1-L2, T12-L1 and T11-T12. There is associated perivertebral soft tissue enhancement. Perivertebral soft tissue enhancement appears to extend towards the neural foramina in the upper lumbar spine and lower thoracic spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level. There is bilateral facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. The L4 and L5 vertebral bodies are fused.At L3-4 there is no significant compromise to spinal canal. There is a left far lateral broad-based disc protrusion present at this level which encroaches on the left-sided exiting nerve roots. There is is associated facet hypertrophy. There is some loss of disc space height present. Overall there is no significant change compared to the prior examAt L2-3 there is no significant compromise to spinal canal. There is a mild posterior subluxation of L2 on L3 which was also present on the previous exam. There is encroachment of the exiting nerve roots bilaterally. The pedical screws appear to be traversing the neural foramina at this level.At L1-2 there is significant artifact which obscures visualization of the spinal canal and neural foramina at this level. To the extent of visualization there is not appear to be spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at level. There is contrast enhancement along the L1 and L2 vertebral bodies and some destruction of the endplates especially the superior endplate of L2.At T12-L1 imaging is obscured by artifact. The neural foramina are narrowed significantly at this level in the spinal canal is mildly narrowed. There is paravertebral soft tissue swelling present and enhancement along the disc space and surrounding the disc spacer. There is some destruction of the superior aspect of the L1 vertebral body and inferior aspect of the T12 vertebral body.There are multiple small renal cysts redemonstrated in the kidneys.There is artifact in the IVC suggesting IVC filter.
1.The patient is status post additional instrumentation along the lower thoracic and upper lumbar spine. Findings raise the question of discitis and osteomyelitis at the surgical levels especially at the T12-L1 and L1-L2. Imaging is partially degraded by metal artifact which may obscure more subtle abnormalities and partly obscures visualization of the lower thoracic spine and upper lumbar spine. Please refer to CT of the lumbar spine from 12/12/2015 for further comments especially with regards to hardware placement.2.There are degenerative changes present in the lower lumbar spine with some encroachment of the left-sided exiting nerve roots at L3-4 related to a disk protrusion. The patient is status post L4-5 anterior and posterior fusion.