Back pain and right lower extremity pain status post TLIF. Postsurgical changes from L5-S1 posterior spinal fusion with bilateral pedicle screws and posterior stabilization rods. Susceptibility artifact from metallic hardware limits evaluation at this level. There is mild anterior wedging of the T12 vertebral body, focally increased kyphosis, and advanced degenerative disc disease with a central disc protrusion at T11-12. This is associated with effacement of the ventral thecal sac and mass effect on the cord. This level is only imaged on the sagittal views, but appears slightly progressed compared to prior.The remaining vertebral body and intervertebral disc heights are maintained. Alignment is likewise otherwise maintained. The spinal cord has normal signal throughout. The conus medullaris terminates at the L1 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Small right paracentral disc protrusion, facet hypertrophy, and hypertrophy of the ligamentum flavum creates moderate subarticular foraminal narrowing on the right which appears mildly progressed compared to prior. No spinal canal or left neural foraminal stenosis.L5-S1: Metallic susceptibility artifact markedly limits evaluation. There is marked narrowing of the right neural foramen by low signal tissue corresponding to the soft tissue density seen on recent CT. No definite enhancement is noted, but evaluation is markedly limited by metallic artifact.
1. Postsurgical changes from L5-S1 posterior spinal fusion. There is a low signal tissue obliterating the right L5-S1 neural foramen corresponding to the soft tissue density seen on prior CT. Although evaluation is limited by metallic artifact, the lack of definite enhancement favors fibrotic postsurgical change.2. Moderate right L4-5 neural foraminal stenosis which appears slightly progressed compared to preoperative MRI.3. Partially imaged central disc protrusion at T11-12 with effacement of the ventral thecal sac and mass effect on the underlying cord also appears slightly progressed compared to the preoperative MRI. No abnormal signal is identified within the cord.