Bilateral leg weakness, evaluate for cord compression. Please note because of discomfort, patient could not be positioned in the conventional manner within the scanner, and as a result image quality is significantly degraded. Examination in the cervical region is of very poor quality. The ventral epidural space in the cervical region shows fairly uniform moderate T1 intensity signal with corresponding dark signal on STIR sequence. Compared to recent prior CTA of the neck this appears to reflect a combination of ligamentous thickening and perhaps some venous engorgement with the possibility of an acute epidural process considered less likely based on this limited evaluation.There is narrowing of the cervical spinal canal particularly at C5-C6 and C6-C7. There is probable myelomalacia of the cord at this level which was also present previously.Within the constraints of degraded examination, no evidence of cord compression is evident in the thoracic region.The evaluation of the lumbar region is again of poor quality due to multiple factors, particularly orthopedic instrument related artifact. There is evidence of previous surgery in the lumbosacral spine with orthopedic instruments significantly obscuring a large part of the spine. As seen previously, there is disc or ossific material projecting posteriorly into the spinal canal at L2-3 level which causes significant spinal canal narrowing and probable impingement of the cauda equina. Similar findings were seen on the prior exam. There appears to be marrow space edema involving L2 and L3. In addition, the L3 vertebral body seems to have lost height relative to the prior exam.In the right paraspinal soft tissues including the musculature, extensive edema and abnormal signal is noted. In particular the right psoas muscle is very edematous and contains a 16 mm focus of low T2 and high T1 signal which could represent hemorrhage. There is a lesser degree of paraspinal soft tissue involvement on the left side.
1. Thickening of the ventral epidural tissues in the cervical spine is felt to most likely reflect ligamentous thickening and/or venous engorgement based on comparison with a recent prior CTA. An acute epidural process is considered less likely. Dedicated C-spine MRI imaging can be considered if the patient can be made comfortable or with anesthesiology assistance.2. No cord compression in the thoracic region.3. Postsurgical findings in the lumbar spine including posterior fusion which significantly limit the evaluation. As in previous exam a high-grade canal stenosis at L2-3 is seen with disc or bony material projecting into the spinal canal appearing similar to the previous exam.4. There is severe edema in the right paraspinal musculature and soft tissues in the lumbar region, right more than left. There appears to be a small fluid collection within the edematous right psoas muscle which may reflect hemorrhage. In addition there is edema involving the L2 and L3 vertebral bodies with suspected further loss of height of the L3 vertebral body. These findings raise the possibility of an infectious process such as osteomyelitis. Further evaluation with dedicated abdomen and pelvis imaging is suggested for further evaluation. Given difficulties with MRI tolerance, CT would be appropriate for this patient.Findings were discussed with Dr. Jacobson by Dr. Kumar at 15:13 hours on 11/6/2015.