Clinical question: History of L5-S1 discectomy. Evaluate scar tissue on the right, or herniation. Patient had a non infused MRI September. Signs and symptoms: Back pain, left foot numbness, right thigh pain. Pre and post enhanced lumbar MRI:The alignment of the vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable.Examination at T11-T12 through L3-L4 levels is unremarkable other than mild hypertrophic changes of the posterior elements.L4-L5 demonstrate mild disc dessication, mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis. There is a central and rightward shallow disc protrusion at this level with resultant right lateral recess and right L5 nerve root mass effect ( Axial T2 series 801 image 14 and sagittal T2 series 401 image 13). Mild right neural foraminal compromise, patent left and no central spinal stenosis.There is post operative changes of left laminotomy (axial T2 series 801 images 14 through 17) with resultant mild expansion of thecal sac and without significant epidural scaring (axial T2 series 801 images 14 through 17). There is no postoperative changes on the right as is requested clinically to be evaluated. L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum and facet hypertrophy changes and no evidence of spinal stenosis or neural foraminal compromise. There is a linear increased T2 signal intensity in the annulus of the disc in the midline with expected enhancement representing an annular fissure.Normal signal intensity of the cor, conus and the cauda equina without abnormal enhancement.The paraspinal soft tissues remain unremarkable.
1.L4-L5 demonstrate degenerative changes as detailed. There is a central and rightward enhancing disc protrusion with resultant mass effect on the right lateral recess and right L5 nerve root. No spinal stenosis however mild right neural foraminal compromise secondary to degenerative changes is also detected. There is evidence of a chronic left-sided laminotomy with minimal epidural scarring. 2.L5-S1 demonstrate degenerative changes without neural foraminal or spinal stenosis. A central enhancing annular fissure at this level is detected.3.Unremarkable exam at other levels.4.There is no detectable postoperative changes on the right as is clinically questioned for evaluation for epidural scarring.