Male, 88 years old, with lower extremity weakness and a history of lumbar laminectomy, abscess. Posterior instrumented fusion has been performed from L4 through S1 with bilateral pedicle screws in place at these levels. An interbody fusion device is also been placed at L5-S1. Laminectomy has been performed at L4, L5 and at least partially at S1.A rim-enhancing fluid collection is evident within the superficial subcutaneous tissues of the operative region spanning from L3 through S1 and measuring 72 mm TV, 26 mm AP and 23 mm CC. This collection communicates via a thin tract with a deeper rim-enhancing fluid collection within the laminectomy bed which measures approximately 46 x 35 x 16 mm. This collection exerts minimal mass effect upon the thecal sac but causes no significant spinal canal stenosis.A grade 1 anterolisthesis of L5 relative to S1 is seen along with a mild exaggeration of the lumbar lordosis. Vertebral body heights are grossly preserved.Abnormal T2 hyperintense signal seen within the L3-4 intervertebral disc and the adjacent endplates. The endplates also show evidence of ill-defined enhancement. No associated paraspinal fluid collection is seen. However, the adjacent psoas muscles are edematous and enhancing.The visualized distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen.L1-2: Minimal disc bulging. Right foraminal/far lateral annular fissuring and protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Prominence of the dorsal epidural fat. Moderate effacement of the thecal sac with some crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet arthropathy. Loss of disc height posteriorly is seen. In addition, there is a superiorly directed right paracentral extrusion measuring up to 16 mm in length which partially effaces the thecal sac. This, along with osseous distortion from surgery and thickening of the epidural soft tissues, contributes to a moderate generalized spinal canal stenosis with crowding of the cauda equina. The neural foramina are not well visualized but are likely significantly narrowed. L4-5: Facet arthropathy. Thickening of the residual ligamentum flavum. Disc bulging. Moderate generalized spinal canal narrowing. Moderate to severe foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging. Mild generalized spinal canal narrowing. The neural foramina are not well assessed but may be mildly to moderately narrowed.
1.Postoperative findings are demonstrated compatible with posterior instrumented fusion from L4 through S1 and laminectomy as above.2.A rim-enhancing fluid collection is evident in the posterior soft tissues. This collection is composed of two components, one within the superficial subcutaneous space and the other located more deeply within the laminectomy bed. The two components communicate via a thin tract. These collections could represent postoperative seromas, but the possibility of infected collections is highly suspected.3.Disc and endplate signal abnormalities are seen centered at L3-4. In the context of associated inflammation of the adjacent anterior paraspinal soft tissues, these findings are concerning for discitis osteomyelitis.4.Multilevel degenerative findings are demonstrated. Most notably, at L3-4 there is a right paracentral superiorly directed disc extrusion. This, in combination with postoperative distortion and epidural thickening, contributes to at least a moderate generalized spinal canal stenosis.