51-year-old female with back pain status post extensive lumbar fusion. Evaluate for spinal abscess/osteomyelitis. Wound infection per recent neurosurgery notes. Detailed evaluation of the previous surgical site is limited secondary to lack of contrast and distortion from adjacent surgical hardware.New since the previous MRI examination is extensive emphysema throughout the dorsal soft tissues, subcutaneous inflammatory change and adjacent skin thickening within the posterior soft tissues of the back. There is a is a small focal fluid collection posterior to surgical hardware, at approximately the L4 level, within the surgical site which measures approximately 25 x 20 7 mm, (axial T2 series 501, image 11).Inflammatory change, fluid density and foci are extends in craniocaudal dimension by approximately 17cm from the inferior aspect of L4 to the superior aspect of T12. There are multiple foci of air within the subcutaneous tissues at this level. This focal collection is concerning for inflammatory change versus infection. Evaluation of bony structures surrounding hardware is limited secondary to metallic artifact. No definitive evidence of osseous or hardware complication.Redemonstrated is a burst fracture present at L3 grossly unchanged compared with MRI dated 7/13/2011. There is posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina and central stenosis, unchanged. Interval development of trace retrolisthesis of L2 on L4, not significantly changed.Compression deformity is central with compression noted of both the superior and inferior endplates of L3. Posterior retropulsion of cortex also affects both neural foramina causing severe stenosis. The visualized lower thoracic spine demonstrates multilevel degenerative endplate change.L1-2: no central neuroforaminal narrowing.L2-3: Mild disk bulge and mild bilateral neural foraminal stenosis, unchanged. L3-4: Compression deformity as described above. Interval postsurgical change of a posterior stabilization device with bilateral pedicular screws entering the vertebral bodies of L2 and L4, without foraminal involvement. Left L3 laminectomy with bony graft, unchanged. No new fracture or hardware compromise is identified. L4-5: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.L5-S1: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.Lung bases demonstrate multifocal linear areas of opacification which may be secondary to scarring, atelectasis or infection/inflammation, not significantly changed compared to the previous examination.
1. No evidence of diskitis or osteomyelitis.2. Interval development of subcutaneous stranding, focal fluid and soft tissue emphysema within the posterior soft tissues as described above, concerning for inflammatory change versus infection. 3. Postsurgical changes of a bilateral posterior stabilization device at L2 and L4 without definitive evidence of hardware or osseous complication.4. Unchanged appearance of an L3 compression fracture with posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina, central stenosis and left greater than right bilateral neural foraminal narrowing.