Back pain and continued fevers in the setting of antibiotics treatment for a pan-susceptible organism. General observations: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is near complete loss of disc space and disc desiccation at L3-4 and L4-5. There is high T2 signal in the bone marrow along the endplates surrounding the L4-5 disc, which contains a small amount of fluid signal. There is milder high T2 signal in the bone marrow along the endplates at L3-4. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is a disc bulge that causes mild to moderate bilateral neural foraminal narrowing, but no significant narrowing of the spinal canal.L4-5: There is a disc bulge asymmetric to the right, ligamentum flavum thickening, and facet arthropathy causes effacement of the right lateral recess and moderate to severe central canal stenosis, as well as moderate left and severe right neural foraminal narrowing. L5-S1: There is a small eccentric right disc bulge with mild bilateral neural foramen narrowing, but no significant compromise to spinal canal.
Lower lumbar spine degenerative spondylosis, particularly at L4-5, with moderate to severe spinal canal stenosis and severe right neural foraminal narrowing. Mild endplate edema and fluid in the disc space at L4-5 is also likely degenerative in nature, although superimposed discitis-osteomyelitis is a potential consideration. However, assessment is limited without intravenous contrast. 