Clinical question: Removal of cystic lesion at L3 -- L4 and L4 -- L5 levels in September of 2012. Follow-up for any recurrence. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:Examination demonstrates an ill-defined increased T2 stir signal intensity in the left paraspinal soft tissues posterior to L4 and L5 level at the site of prior tumor resection. Post enhanced images also demonstrate a very faint subtle enhancement at the site. There is interval improvement (less conspicuous enhancement and signal abnormality) of the finding since prior exam highly suggestive of improvement of post operative changes. There is no convincing evidence of residual tumor. The alignment of the vertebral column remains anatomical and the signal intensity of vertebral column demonstrate changes related to degenerative disease. Post enhanced images demonstrate expected enhancement of degenerated/hypertrophied facet complexes at L3 -- L4 through L5 -- S1 levels of varying degree.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise or interval change since prior exam.L2 -- L3 demonstrate mild degenerative disease a mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis or neural foraminal compromise or interval change.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of above changes results in moderate central spinal stenosis without convincing evidence of interval change since prior exam. No neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate to severe bilateral facet and mild bilateral ligamentum flavum hypertrophic changes are noted. Mild central spinal stenosis and mild right neural foraminal compromise similar to prior exam.L5 -- S1 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise or interval change since prior exam.
1.Post operative changes in the soft tissues of the posterior lower back at L3 -- L4 and L4 -- L5 levels at the site of previously resected tumor without evidence of residual tumor.2.Stable degenerative changes of the lower lumbar spine with evidence of moderate central spinal L3 -- L4 and mild at L4 -- L5 levels. No significant neural foraminal compromise. stenosis