Male, 61 years old, with severe back pain which limits ambulation. The L4 and L5 vertebral bodies are diffusely edematous and enhancing. The intervening disc space, while not enhancing, does show marked abnormal T2 signal. The adjacent endplates have become very irregular indicating likely erosion.Thickened enhancing soft tissue fills the ventral epidural space at L4 and L5. The dorsal epidural space is affected to a lesser degree, but the dura is diffusely enhancing beginning at the L3 level and continuing down into the sacrum. No obvious epidural fluid collections are seen at this time. However, the epidural soft tissue thickening does result in a severe narrowing of the thecal sac at L4 with crowding and possible compression of the cauda equina nerve roots. The L4-5 neural foramina are also significantly encroached upon by this soft tissue process.The anterior and posterior paraspinal soft tissues at L4 and L5 are edematous and hyperenhancing with involvement of the psoas muscles. No discrete fluid collection is seen, however. A 4 mm focus of enhancement is evident along the right posterior surface of the conus at T12-L1. An additional very small focus of enhancement is seen within the thecal sac at the S1-2 level. Spinal alignment is anatomic. Vertebral body heights are preserved. Except as discussed above, marrow signal characteristics are unremarkable.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc desiccation and mild disc bulging. Progressive prominence of the dorsal epidural soft tissues. Progressive encroachment upon the thecal sac but no frank nerve root compression. Moderate bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy and ligamentum flavum thickening, slightly progressed from prior. Disc bulging with a superimposed central annular fissure. Extensive inflammatory findings as above. Significant generalized spinal canal stenosis and significant bilateral foraminal narrowing, progressed from prior. L5-S1: Facet arthropathy. Bulging disc asymmetric to the left. No significant generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing.
Findings at L4 and L5 compatible with osteomyelitis discitis. The epidural tissues at these levels are thickened with solidly enhancing soft tissue which contributes to a significant narrowing of the thecal sac at L4 and significant L4-5 foraminal encroachment. No definite abscess is identified at this time.The dura of the lower sac is diffusely enhancing compatible with reactive inflammation. However, note is made of two intrathecal foci of enhancement, one at T12-L1, and one at S1-2, which are nonspecific but could potentially represent areas of intrathecal infection.Findings were discussed with the hospitalist service at pager 5866 on 2/26/16 at 1:20 PM.