 There is bone marrow edema involving the L4 and L5 vertebral bodies, which has significantly diminished since 3/5/2016. There is loss of disc height at the L4-5 level is redemonstrated. There remains diffuse enhancement in the L4-5 disc space and the adjacent vertebral bodies and paraspinal soft tissues. However, there is an area of nonenhancement in the posterior paraspinal soft tissues adjacent to the left fact joint at L3-4 that measures up to10 mm, with enhancement of the underlying facet. The L4 vertebral body height has decreased since 3/5/16 and there is persistent extensive erosion of the L5 superior endplate. There remains severe spinal canal stenosis at L4-5, as well as moderate to severe bilateral neural foraminal stenosis due to a disc-osteophyte complex and ligamentum flavum thickening. There is also moderate spinal canal stenosis and mild bilateral neural foraminal stenosis at L3-4, as well as a disc-osteophyte complex and facet hypertrophy at L5-S1 with mild spinal canal narrowing and moderate bilateral neural foraminal stenosis. There is a small Schorl node in the inferior L3 vertebral body. In addition, degenerative bone marrow signal alterations and irregularity persist alongside the endplates alongside the L5-S1 disc space. There are subcentimeter posterior synovial cysts at multiple levels between L3 and S1 on the right side with associated enhancement. There is mild diffuse epidural lipomatosis. There appears to be clumping and deviation of the nerve roots towards the left and anteriorly at the L2 and L3 levels, measuring up to 5 mm in axial cross-section. There is mild hyperenhancement of the overlying posterior dura. In addition, there is a persistent small area of high T2 signal and enhancement within the right aspect of the spinal cord at the T12-L1 level. There is a punctate enhancing lesion in the spinal canal at S1-2. There is atrophy of the bilateral kidneys and a renal transplants.
1. Decreased inflammation related to prior discitis-osteomyelitis at L4-5, with interval increased loss of height of the L4 vertebral body. Furthermore, degenerative spondylosis at L4-5 results in marked spinal canal narrowing.2. Apparent clumping and deviation of the nerve roots towards the left and anteriorly at the L2 and L3 levels may represent arachnoiditis, perhaps related to the overlying dural inflammation. 3. A persistent small area of high T2 signal and enhancement within the right aspect of the spinal cord at the T12-L1 level may represent a vascular lesions, neoplasm, and less likely infection, for example.4. A small area of nonenhancement in the inflamed posterior paraspinal soft tissues adjacent to the left facet joint at L3-4 may represent abscess formation with what may represent underlying facet osteomyelitis.5. An unchanged punctate enhancing lesion in the spinal canal at S1-2 may represent a schwannoma or other neoplasm.6. Degenerative spondylosis at L3 through S1. Subcentimeter posterior synovial cysts at multiple levels between L3 and S1 on the right side with associated enhancement, which may represent superimposed inflammation.