Male, 69 years old, with persistent bacteremia, history of discitis. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow edema or marrow replacement is detected. A right paracentral, superiorly directed disc extrusion at C3-4 impinges upon the spinal cord but causes no clear spinal cord edema. Elsewhere in the cervical region, only minimal disc degeneration is seen without high-grade spinal canal stenosis or cord impingement. Neuroforaminal narrowing is evident bilaterally at C3-4, on the left at C6, and on the left at C6-7. The spinal cord shows normal signal intensity throughout.Thoracic:On comparison with the prior examination, there is new T2 signal abnormality within the T8-9 intervertebral disc as well as new irregularity of the adjacent endplates along with worsened edema within the T8 and T9 vertebral bodies. There is edema in the adjacent left paraspinal soft tissues, but no discrete fluid collection is identified. Bulging of the T8-9 disc causes slight effacement of the ventral thecal sac but no high-grade spinal canal stenosis. The T8-9 neural foramina are narrowed. No discrete epidural fluid collection is seen. Minimal nonspecific signal abnormality is seen along the inferior T10 endplate. Vertebral body heights are preserved. Spinal alignment is anatomic. Incidental note is made of 13 rib bearing vertebral bodies. The spinal cord demonstrates normal signal intensity and morphology.Lumbar:Mild edema within the L2-3 vertebral bodies appears similar to the prior examination. The intervening disc, however, shows some loss of height with persistent abnormal disc T2 signal. No evidence of an associated epidural fluid collection is seen. The psoas musculature is less edematous and the previously demonstrated small fluid collection within the left psoas is no longer clearly appreciated. No new paraspinal collections are seen. No new areas of marrow or disc signal abnormality are detected. A right paracentral/foraminal disc protrusion at L2-3 is again seen. Facet arthropathy, ligamentum flavum thickening and disc bulging result in moderate spinal canal stenosis at L3-4 and moderate to severe canal stenosis at L4-5. Significant bilateral foraminal narrowing is demonstrated from L2-3 through L4-5. Alignment is anatomic. The kidneys are small and contain numerous cysts.
1.Persistent signal abnormality is seen within the L2-3 disc and vertebral bodies compatible with discitis-osteomyelitis. Although the disc demonstrates some interval loss of height, the overall extent of involvement is unchanged. A small suspected abscess within the left psoas muscle has resolved.2.Since the prior examination, findings consistent with discitis osteomyelitis have developed at the T8-9 level. No epidural or paraspinal abscess is suspected at this level.3.The cervical spine shows no evidence of infectious involvement. A disc extrusion at C3-4 is noted incidentally with associated mild spinal cord impingement.