Low back pain with history of back surgery. Evaluate for discitis. Per EPIC: chronic low back pain s/p L4-S1 spinal fusion 11/20/15, DM II, HTN, and h/o of prostate cancer s/p radical prostatectomy and radiotherapy. There are postoperative findings related to posterior decompression and instrumented fusion from L4 through S1 with bilateral pedicle screws affixed to posterior contoured stabilization rods. A disc spacer is demonstrated within the L5-S1 intervertebral disc space. There is mild anterolisthesis of L5 on S1 with accentuation of the normal lumbar lordosis. There is irregularity involving the L5-S1 endplates with loss of vertebral body height and bone marrow edema and enhancement in the L5 and S1 vertebral bodies. There is also enhancement involving the soft tissues anterior to the vertebral bodies. In addition, there is a fluid collection that measures up to 15 mm anterior to the L5-S1 disc space. There is no evidence of epidural fluid collections. Assessment of this region is otherwise limited by metal hardware artifacts. There is multilevel degenerative disc spondylosis present. At L1-2, there is disc bulging resulting in mild effacement of the ventral thecal sac, without significant spinal or neural foraminal stenosis. At L2-3, there is a mild disc bulge causing mild spinal stenosis and mild bilateral neural foraminal narrowing. There are mild posterior facet degenerative changes as well. At L3-4, there is a mild disc bulge causing mild narrowing of the bilateral neural foramina, without evidence for spinal stenosis. At L4-5, there is susceptibility artifact from indwelling hardware limiting evaluation. There is loss of intervertebral disc space with a disc bulge. There is suggestion of at least mild to moderate bilateral neural foraminal narrowing at this level. There is diffuse fatty replacement of the sacral marrow likely related to prior radiation treatment. There imaged portions of the spinal cord are unremarkable. The left psoas muscle and bilateral posterior paraspinal muscles are atrophic.
1. Postoperative findings related to posterior fusion from L4 to S1 and placement of intervertebral disc spacer at L5-S1. The L5-S1 endplates appear irregular with mild anterolisthesis and loss of vertebral body height, as well as inflammation of the bone marrow, disc space and anterior paraspinal soft tissues, which likely represents discitis-osteomyelitis. A small fluid collection is present anterior the the L5-S1 disc space, but there is no evidence of epidural abscess.2. Multilevel degenerative spondylosis of the lumbar spine as described above.