Female, 70 years old, with profound lower extremity weakness, hypotension without etiology, prior MRI with notable diskitis. Severe endplate irregularity, loss of disk height and some loss of vertebral body height is evident at T11-12. These findings are similar to those noted on the prior body CT but are new when compared to an older lumber spine MRI from 2012. The degenerated disk space, and likely the right anterior projecting disk osteophyte complex, demonstrate elevated STIR signal, but the remainder of the vertebral body marrow space does not. Please note that these findings are only assessed on sagittal images as the axial field of view does not extend to this level.Spinal alignment is grossly anatomic. Except as above, vertebral body heights are preserved. A Schmorl's node has progressed along the inferior L3 endplate. Marrow signal characteristics are heterogeneous but benign. The visualized spinal cord and conus demonstrate normal signal intensity. Additional level specific findings are as follows:T11-12: Facet hypertrophy and ligamentum flavum thickening. Progressive loss of disk height and disk bulging. Prominence of the dorsal epidural fat. Findings contributes to produce a moderate generalized spinal canal stenosis with possible slight impingement on the conus. Severe right and moderate left neuroforaminal narrowing. Findings are new relative to prior. T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing. L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No interval changes.L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L3-4: Moderate facet hypertrophy with a left facet effusion and ligamentum flavum thickening, progressed. Moderate bulging disk with a superimposed right paracentral protrusion. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate left and mild right foraminal narrowing, unchanged. L4-5: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate bilateral foraminal narrowing, unchanged. L5-S1: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate bulging disk, progressed. Moderate to severe generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing, unchanged. The kidneys are atrophic.
1. Severe deformity involving the disk space and endplates at T11-12 is similar to that seen on a recent body CT but new when compared to a prior MRI from 2012. Findings are only partially images on the present exam. Abnormal signal is evident within the severely deformed disk space and perhaps also the associated disk osteophyte complex, but not necessarily within the adjacent vertebral body marrow. Differential diagnosis would include severe disk degeneration, sequela of prior trauma or sequela of prior infection. Ongoing active infection is considered a less likely possibility, but correlation with clinical and laboratory parameters should be made.2. Along with disk space deformity, there is a new bulging disk at T11-12 which results in a moderate generalized canal stenosis and perhaps slight impingement of the conus.3. Moderate to severe degenerative findings are seen at additional levels in the lumbar spine with areas of slight progression as indicated above. L3-4 through L5-S1 are the most severely affected levels where disk disease and posterior element hypertrophy contribute to causing moderate to severe spinal canal stenoses.