Male, 72 years old, neurogenic claudication in the bilateral legs, history of prior surgery, questionable report of "cannot rule out infection". Image quality is degraded by motion artifact. Within this limitation the following observations are made.Again seen are findings related to posterior decompression from L3 through L5. STIR hyperintense edema persists within the posterior paraspinal musculature at the L5 level and below.Loss of vertebral body height is seen at L4, and particularly at L5 which shows anterior wedging. The L4-5 endplates are irregular and the disk space shows T2 hyperintense signal similar to prior exam. Substantial edema is noted within the marrow adjacent to the endplates. There is corresponding enhancement within the vertebral body marrow but not within the disk space. Edema is evident along the L4-5 facets. The ventral epidural space posterior to L5, and continuing down into the sacrum, is expanded and enhancings, but without evidence discrete fluid collection. Allowing for substantial artifact on both examinations, there has been no significant interval change in the noncontrast portion of the exam.L1-2: No spinal canal stenosis or neuroforaminal narrowing. L2-3: No spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy. Bulging disk toward the foramina. Mild bilateral foraminal narrowing. No significant spinal canal stenosis. No changes. L4-5: Moderate facet hypertrophy. Bulging disk. Mild spinal canal narrowing. Severe bilateral foraminal narrowing. No changes.L5-S1: Moderate facet hypertrophy. Bulging disk with osteophytic ridging. Thickening of the ventral epidural space. Mild/moderate spinal canal narrowing. Moderate bilateral foraminal narrowing. No interval changes.
Allowing for substantial artifact on the present and prior exam, no significant interval change is demonstrated in the precontrast appearance of the L4 and L5 vertebral bodies and intervening disk space. There is enhancement which corresponds to marrow edema along the L4-5 endplates, and the disk space is hyperintense, but the disk space does not enhance. No definite evidence of any epidural or paraspinal fluid collection is seen. Given the relative stability of the findings and the lack of disk enhancement, findings may simply represent severe degeneration. Infection is considered less likely, particularly if there are no supportive clinical or laboratory findings.Postoperative findings are redemonstrated in the lower lumbar spine. Stable degenerative disease is demonstrated resulting in spinal canal stenosis at L4-5 and L5-S1. Severe foraminal narrowing is demonstrated bilaterally at L4-5, with moderate foraminal narrowing at L5-S1.