Female, 68 years old, with drainage from the lower back status post L3-L5 XLIF with percutaneous screws. Findings are seen compatible with posterior instrumented fusion from L3 through L5 and interbody fusion at L3-4 and L4-5. Instrumentation is better assessed on prior CT.Several small rim-enhancing fluid collections are identified within the posterior subcutaneous soft tissues of the operative region. For example, irregularly marginated collections are evident to the left of midline at L4 and to both sides of midline at L5. These collections range in size from 1 to 2 cm in diameter but they are thin.Several rim-enhancing fluid collections are also evident within the bilateral psoas muscles beginning at the L3 level and continuing down to L5. The adjacent psoas musculature is edematous. The largest collection is on the left and measures 20 x 15 x 13 mm.No evidence of any epidural fluid collection is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits.Anterolisthesis of L3 relative to L4 seen on the preoperative examination has been corrected. Sagittal alignment is grossly anatomic. Vertebral body heights are preserved. No marrow signal abnormalities are observed which could not be attributable to the recent surgical instrumentation. No definite pathologic marrow enhancement is seen.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Marked facet arthropathy with progressive facet effusions. Ligamentum flavum thickening. Improved disc bulging. Improved mild generalized spinal canal stenosis. The left lateral recess remains narrowed. Severe left foraminal narrowing, unchanged. L4-5: Marked facet arthropathy with improvement in facet effusions. Ligamentum flavum thickening. Mild bulging disc, improved. Mild spinal canal stenosis, improved. Moderate to severe right foraminal narrowing, unchanged. L5-S1: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes.
1.Findings are seen compatible with recent posterior instrumented fusion from L3 through L5 as well as interbody fusion at L3-4 and L4-5.2.Small rim enhancing fluid collections are evident within the posterior soft tissues of the operative region. In addition, there are several small fluid collections within the bilateral psoas muscles measuring up to 2 cm in diameter with adjacent edema. Collectively, these findings are concerning for infected collections, though postoperative seroma with granulation tissue could also present similarly.3.No evidence of any epidural fluid collection or significant compromise of the spinal canal is seen.4.Multilevel degenerative findings are seen, improved at some levels secondary to surgery, with details as above.