Male, 89 years old, with history of L2 deformity, history of kyphoplasty, eval for discitis. A chronic compression deformity of the L2 vertebral body, with evidence of prior kyphoplasty, is unchaged. There is no significant marrow edema at this level.A compression deformity of the L3 vertebral body has mildly progressed in severity with a slightly greater degree of retropulsion and thecal sac effacement. Marrow edema has, however, improved from the prior exam.Interval loss of disc height at L2-L3 is seen with only trace residual fluid signal present in the disc space. Stable loss of disc height is seen at L1-2, L3-4 posteriorly, and L4-5. No edema is seen in any of these discs.Post contrast images show relatively diffuse enhancement of the marrow of the compressed L2 and L3 vertebral bodies. No enhancement is seen in the L2-3 disc space, or any of the adjacent disc spaces. The dura at L2 and L3 is circumferentially enhancing, but no fluid collections are seen. The right psoas muscle is enhancing at L3, but again, no fluid collections are seen. Spinal alignment is grossly anatomic and unchanged. No other marrow space lesions are seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. L1-2: Facet arthropathy, ligamentum flavum thickening, disc bulge and slight vertebral body retropulsion contribute to a moderate spinal canal stenosis, moderate left and mild-moderate right foraminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening are unchanged. Disc bulge and vertebral body retropulsion have progressed with a worsened, severe spinal canal stenosis with effacement of CSF and crowding of the cauda equina. A prior right paracentral extrusion has, however, improved. Severe right and moderate left foraminal narrowing have not changed.L3-4: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate spinal canal stenosis and moderate left foraminal narrowing. No interval changes. L4-5: Facet arthropathy, ligamentum flavum thickening, and disc bulge contribute to moderate left and mild right foraminal narrowing, unchanged. L5-S1: Facet arthropathy and disc bulging are unchanged with no significant spinal canal or foraminal stenosis.
1.No change in the L2 vertebral body compression deformity with evidence of prior kyphoplasty.2.Progressive compression of the L3 vertebral body when compared to the prior exam. However, the degree of marrow edema has improved.3.Progressive loss of height of the L2-3 disc is seen, with only trace residual fluid signal in the disc space. 4.Enhancement of the L2 and L3 marrow, the adjacent dura, and the right psoas muscle is seen. Although infection cannot be excluded with certainly on the basis of imaging alone, all these findings could potentially be reactive to the severe compressions and disc degeneration. Lack of fluid collections, and resolving L3 edema argue against infection.