 There has been interval expected evolution of postoperative changes centered at the L1-L2 level from previous cord untethering. There is again perhaps subtle clumping of dorsal nerve roots at the L1-L2 level, greater on the left side. The current sagittal supine images include a decreased cranial extent of the T11 vertebral level as compared to prior exam, although on prone imaging there is perhaps suggestion of subtle decrease in the previously noted kinking of the distal cord at the upper T11 level. There is otherwise no significant change in the appearance of the ventrally positioned lower thoracic cord compared to preoperative imaging. The conus more inferiorly remains more dorsally positioned at the L1 level, with appropriate ventral motion of the cauda equina roots upon prone imaging. Previously, the conus termination was noted to be at L1-L2, now at the lower L1 level. There is no definite delineation of the reported split cord appearance seen at time of surgery appreciated on MRI.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. The bladder is significantly distended. There is extensive air distention of the visualized colon and rectum.
1. Interval expected evolution of previously seen postoperative changes related to cord untethering. Overall appearance of the thoracolumbar spinal canal and distal cord/conus is similar except for questioned slight decreased focal kinking at the T12 level although somewhat incompletely evaluated. The conus also appears slightly more cranially positioned than on prior exams.2. Prone images again demonstrate appropriate ventral motion of the cauda equina nerve roots without significant conus position change.3. Stable subtle clumping of the left greater than right cauda equina nerve roots at the L1-L2 level likely relating to mild postsurgical arachnoiditis.