 Moderate degenerative changes in the cervical spine are partially imaged on the sagittal counting sequence and appear grossly similar to prior study from 7/1/2016. There is at least moderate degree of spinal canal stenosis at the C2-C3 and C3-C4 levels.THORACIC SPINE: Again seen is evidence of discitis-osteomyelitis at the T10-T11 level with edema and enhancement involving the T10-T11 disc space with extension into the epidural space. There has been slight interval increase in erosive changes involving the inferior T10 endplate and stable to minimal worsening of anterior vertebral body height loss at the T11 level.Remainder of the thoracic intervertebral disc levels demonstrate no significant edema or enhancement to suggest new level of discitis-osteomyelitis. Multilevel degenerative changes are again seen including a small right paracentral disc protrusion at the T1-T2 level with mild spinal canal stenosis including mild deformity of the right ventral aspect of the cord, not appreciably changed in the interval. Minimal left paracentral disc protrusion is also evident at the left T6-T7 level also not significantly changed.Circumferential epidural enhancement at the T10-T11 level is again seen and in combination with disc bulge, ligamentum flavum thickening, and facet arthropathy contributes to severe spinal canal stenosis and cord deformity similar to prior. The extent of epidural enhancement is stable to minimally decreased in the interval. There is T2 hyperintense cord signal abnormality at the T10-T11 level which is again evident and similar to prior. There is also moderate to severe neural foraminal stenosis at the T10-T11 level similar to prior.Previously seen multiloculated paraspinous abscess centered at the T10-T11 level demonstrates mild decrease in size and demonstrates more homogeneous enhancement which may represent residual phlegmon and/or granulation tissue. No new fluid collection. LUMBAR SPINE: For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. The lumbar spine is in normal alignment aside from minimal L4 on L5 anterolisthesis.. The vertebral body heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The conus terminates at the lower limits of normal at the L2-L3 level.There is no edema or abnormal enhancement involving the disc spaces to suggest discitis-osteomyelitis. No epidural abscess in the lumbar spine. No paraspinous collections in the lumbar spine.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with right foraminal protrusion component. There is mild right and minimal left neural foraminal stenosis. No significant spinal canal stenosis.L3-L4: Disc bulge with right foraminal protrusion component. Small dorsal annular fissure. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. L4-L5: There is minimal anterolisthesis. Small dorsal annular fissure. There is a disc bulge with partial effacement of the lateral recesses. There is also facet arthropathy and ligamentum flavum thickening contributing to mild central spinal canal stenosis. There is moderate bilateral, right worse than left, neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.
1. Again seen is evidence of discitis-osteomyelitis at the T10-T11 level with evidence of extension into the epidural space as well as the paraspinous soft tissues. Overall findings are slightly improved since 7/1/2016. In particular, the paraspinous fluid collection demonstrates mild decrease in size is now more homogeneously enhancing suggesting residual phlegmon and/or granulation tissue. Interval increased lytic changes at the inferior T10 endplate and stable to minimal worsening of anterior vertebral height loss of T11 may represent evolving sequela of infection rather than progression of infection. However, there remains severe spinal canal stenosis at this level with cord deformity and cord edema similar to prior.2. No evidence of discitis-osteomyelitis or epidural abscess in the lumbar spine or elsewhere in the thoracic spine.3. Mild multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is mild spinal canal stenosis and moderate, right greater than left, neural foraminal stenosis. In the thoracic spine, degenerative changes include a small right paracentral T1-T2 disc protrusion with mild spinal canal stenosis. Moderate degenerative changes in the cervical spine are partially imaged.