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This was a patient who had low back pain,

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which was referable to the S1 nerve

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root, and has an L5-S1 disc herniation.

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You can see that the patient has already

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been operated on with a laminectomy

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defect at the L5-S1 level.

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Here is a postoperative fluid collection

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at the L5-S1 level.

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What I'd really like to demonstrate on

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this case is the modic changes

0:27

that are associated with it.

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So on our T1-weighted scan,

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we see that the inferior endplate of

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L5 shows decreased signal intensity

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compared with the normal bone

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marrow above and below.

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On the T2-weighted scan,

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you recognize that this is bright in

0:49

signal intensity, both in the inferior

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endplate of L5, as well as

0:54

the superior endplate of

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S1, which is verified on the STIR sequence,

1:04

that being bright on T1...

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on the STIR,

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as well as bright on the superior endplate of S1...

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S1 superior endplate a little bit less

1:15

prominent than what we're seeing at

1:17

the inferior endplate of L5.

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So looking at this patient who has

1:23

had surgery and has disc disease,

1:26

we would ascribe this to type I

1:29

endplate changes or modic type 1 changes.

1:34

What some people have worried about is

1:36

could this be, particularly in a patient

1:39

who has been instrumented and operated,

1:44

could this be a superimposed low grade

1:47

infection that one might see in an

1:50

osteomyelitis with propionibacterium acne?

1:54

Just for the sake of completion,

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I'm just going to show the axial T2-weighted images

2:01

to demonstrate for you that large disc herniation

2:04

on the left side,

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which is compressing both the S1

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nerve root, as well as the intrathecal

2:10

S2 nerve root on the left side.