Fecal incontinence and foot numbness. Known L4/L5 osteomyelitis and discitis. Assess for worsening. The contrast-enhancing edema involving the L4 and L5 vertebral bodies remain unchanged. Contrast enhancement within the anterior central part of the intervening L4-L5 disc has slightly increased. The associated anterior epidural contrast enhancement at L4 and L5 levels as well as S1 is not significantly changed. The mild dorsal contrast-enhancing thickening and minimal infiltration of the overlying fat is minimally increased, now extends from mid L3 level to L5-S1 level. There continues to be no definite, drainable fluid collection in the epidural space. However, the dural/epidural involvement is associated with severe spinal canal stenosis at L4 and the upper L5 levels, which is unchanged. There is also persistent abnormal contrast enhancement bilaterally in the L3-L4, L4-L5 and L5-S1 neural foramina. The paraspinal extension of the infectious process into the medial aspect of the psoas muscles and the paraspinal fat remains unchanged. The small reactive internal iliac lymph nodes are slightly larger. There continues to be no discrete paraspinal fluid collection. Otherwise, there has not been significant change since the previous examination regarding the alignment or the multilevel degenerative change. The 4 mm focus of contrast enhancement involving the right posterior lateral aspect of the conus at T12-L1 is unchanged. The other very small focus of enhancement in the thecal sac at the S1-2 level is also unchanged.
1.The findings related to L4/L5 discitis and osteomyelitis are not significantly changed. Epidural phlegmonous involvement also is not significantly changed but again noted to cause severe spinal canal stenosis at L4 and upper L5 levels. Also, the involvement of the paraspinal soft tissues remains unchanged. No drainable paraspinal fluid collection/abscess. 2.The tiny foci of contrast enhancement in relation to the conus medullaris at T12-L1 and one of the nerve roots on the left side at S1-S2 level are favored to represent incidental findings, for example small schwannomas, and appear to be present dating back to 12/29/2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.