Bacteremia. Back pain, L4-L5 facet joint fluid collection. Assess for resolution. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is a Schmorl's node involving the superior T12 endplate. Alignment is within normal limits. Bone marrow signal is benign with mild nonspecific heterogeneity. The conus medullaris is normal in position.Mild degenerative changes are present including minimal disc bulges at L3-L4, L4-L5, and L5-S1. There is no significant spinal canal stenosis at any level. There is mild left and minimal narrowing of the right L3-L4 and L4-L5 neural foramina related to minimal disc bulges and moderate bilateral facet arthropathy. There is also at least moderate facet arthropathy involving the L5-S1 facet joints, worse on the left than the right. There is moderate narrowing of the left L5-S1 neural foramen related to enhancing soft tissue as described below:Subcentimeter fluid collection posterior to the left L4-L5 facet joint is no longer present. There remains edema in the left posterior paraspinous musculature at the left L4-L5 level which is not significantly changed. There is increase in enhancement extending into the left L4-L5 neural foramen. There is more significant interval increase in enhancement surrounding and within the left L5-S1 facet joint, adjacent paraspinous musculature, new epidural enhancement along the left lateral L5 to S1 levels, left L5-S1 neural foramen surrounding the S1 nerve root and to a milder degree left S1-S2 neural foramen. There is trace fluid in the left L5-S1 facet joint which is increased in the interval.There is no edema or abnormal enhancement within the intervertebral discs or endplates to suggest discitis-osteomyelitis.There are small cysts in the bilateral kidneys which are incidentally noted.
1. Previously seen fluid collection posterior to the L4-L5 facet joint is no longer present. 2. There is significant interval increase in enhancement within and adjacent to the left L5-S1 facet joint which extends into the left L5 to S1 lateral epidural space, adjacent paraspinous soft tissues as well as the left L5-S1 neural foramen surrounding the left L5 nerve root. Milder increase in enhancement surrounding the left L4-L5 and left S1-S2 neural foramina is also noted. These findings are highly suspicious for progression of infection. No new fluid collection to suggest paraspinous or epidural abscess.