 Examination is somewhat limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is slight interval decrease in the extent of abnormal STIR hyperintensity. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy superimposed upon edema. There is interval decrease in size of the previously seen loculated collections within the psoas muscles.The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Small amount of focal epidural fat is again incidentally noted along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts.
1. Expected evolution of L1-L2 discitis/osteomyelitis with slightly decreased associated marrow edema. Stable extent of collapse of the L1 greater than L2 vertebral bodies with persistent moderate spinal canal and bilateral foraminal stenosis.2. Interval decrease in size of fluid collections within the psoas muscles, with persistent edema and possible superimposed atrophy/degeneration of the psoas muscles, iliacus muscles and dorsal paraspinal muscles. 