Chronic osteomyelitis. Assess changes in osteomyelitis, elevated CRP and history of osteomyelitis and psoas abscess infection. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits aside from slight collapse of the left lateral aspect of the endplates at the L2-L3 level. There is dextroscoliosis at the L2-L3 level which was present previously. There has been improvement in previously seen findings of discitis-osteomyelitis at the L2-L3 level with marked decrease in edema and enhancement involving the L2 and L3 vertebral bodies as well as the intervening intervertebral disc space. Paravertebral enhancement at the L2-L3 level is also improved. Mild residual signal abnormalities at this level are nonspecific. Paravertebral enhancement at L3-L4 has improved. There is mild edema involving the L3-L4, L4-L5, and L5-S1 disc spaces and adjacent endplates, which compared to 4/15/2016 demonstrates mild increase involving the left aspect of the superior L4 endplate, as well as the right aspect of the L4-L5 and L5-S1 endplates. Mild enhancement involving the right paravertebral soft tissues at the right L5-S1 level is again seen with interval increase in enhancement extending posteriorly to the L4-L5 and L5-S1 facet joints. There are also two enhancing lesion involving the right aspect of the sacrum at the S1 and S2-S3 levels measuring approximately 1 centimeter.No residual or new fluid collections in the paraspinous soft tissues to suggest abscess. There is also no evidence of epidural abscess.Distal spinal cord and cauda equina nerve roots are unremarkable. Multilevel degenerative changes are again seen without significant central spinal canal stenosis at any level. There is mild left L1-L2, mild to moderate left L2-L3, mild to moderate left L3-L4, and mild to moderate right L5-S1 neural foraminal stenosis.
1. Compared to 4/15/2016 and 2/17/2016, signal abnormalities related to discitis-osteomyelitis at L2-L3 continue to improve. Paravertebral enhancement at L3-L4 is also improved.2. Edema and enhancement involving the L3-L4, L4-L5, and L5-S1 discs and adjacent endplates are again seen and are nonspecific. There are however areas of interval increase in signal abnormalities involving the right lateral L4-L5 and right L5-S1 levels extending into the posterior elements as well as new enhancing lesions involving the right aspect of the sacrum. These are concerning for worsening osteomyelitis, especially the new enhancing foci in the sacrum3. No residual or new fluid collections in the paraspinous soft tissues to suggest abscess. No epidural abscess.