Clinical question: 35-year-old G2 P1 at 31 weeks with history of tethered spinal cord status post release, evaluate lumbar spine prior to epidural placement for C-section. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column.There is revisualization of postoperative changes of prior cord untethering evident by posterior laminectomy at L4 and L5 without change.Compared to prior exam there is a slight prominence of the ventral epidural space demonstrating T2 hypointensity which is believed to represent engorged epidural venous plexus secondary to patient's pregnancy. This finding is best appreciated on sagittal T2 weighted images.There is termination of the cord at L2-L3 disc level similar to prior exam. The signal intensity of the lower most visualized thoracic cord, conus and cauda equina is within normal and there is no evidence of spinal canal compromise or stenosis at any level. There is no detectable fatty signal intensity of the filum.No significant degenerative changes of the spine and no evidence of neural foraminal or lateral recess compromise at any level.Unremarkable perispinal soft tissues other than chronic stable postoperative changes of prior cord untethering.
1.Compared to prior study there is mild prominence of the ventral epidural space with T2 hypointensity suggestive of engorged epidural venous plexus secondary to patient's pregnancy.2.Stable post operative changes of cord untethering as detailed.3.There is termination of the cord at L2-L3 disc level and with normal signal intensity of the lower thoracic cord, conus and the cauda equina.4.No spinal stenosis or neural foraminal compromise.