Male, 54 years old, with intraspinal abscess, reevaluate burden of epidural abscess and soft tissue infection. Symptoms include right hip and knee flexion and extension weakness, and left knee weakness. STIR hyperintensity within the L4 and L5 vertebral bodies has become more uniform and more intense, as has marrow space enhancement. T2 hyperintensity within the L4-5 disc space has diminished compared to prior but the disc space itself has lost some height. Vague STIR hyperintensity and patchy enhancement within the L2 and L3 vertebral bodies appears grossly similar to the prior examination.The previously seen large ventral epidural abscess has significantly decreased in size. A discrete fluid collection is no longer seen, but rather, there is a band of solid enhancement within the ventral epidural space spanning the L4-S1 levels. The thecal sac has reexpanded with significant relief of the previously seen encroachment and nerve root crowding. Paraspinal edema and enhancement persists, most notably at the L5 and S1 levels. However, the previously seen left psoas abscess is no longer clearly identified.Mild posterior wedging of the L5 vertebral body is unchanged, as is a 7 mm anterolisthesis of L5 relative to S1. Spinal alignment is otherwise unremarkable. The remaining vertebral body heights are preserved. Marrow signal change likely related to disc degeneration at L2 and L3 is redemonstrated.The distal spinal cord and conus are unremarkable. Enhancing nerve roots are seen within the left aspect of the cauda equina. The posterior dura of the lower thecal sac is also mildly enhancing but reduced from prior.L1-2: Facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet hypertrophy. Ligamentum flavum thickening. Left disc height with disc bulging. Moderate spinal canal narrowing, improved. Moderate bilateral foraminal narrowing, unchanged. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild spinal canal narrowing, improved from prior. Moderate bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Disc bulging. Mild spinal canal narrowing, improved from prior. Severe foraminal narrowing, similar to prior. L5-S1: Facet arthropathy. Disc bulging and disc uncovering. No significant spinal canal stenosis. Severe bilateral foraminal narrowing, unchanged.
1.Since the prior examination, the previously seen large ventral epidural abscess has largely resolved leaving behind a band of solid enhancing tissue in the ventral epidural space which likely represents granulation. A previously seen left psoas abscess has also resolved.2.The previously seen significant encroachment upon the thecal sac in the lumbar region has been relieved. There appear to be two or three enhancing nerve roots within the left aspect of the cauda equina which may represent a post compressive radiculopathy or mild arachnoiditis.3.Signal abnormality and enhancement within the marrow space of the L4 and L5 vertebral bodies have become more uniform and intense. However, this is an expected finding in discitis-osteomyelitis as the findings on MRI imaging often lag behind clinical response.4.Vague signal abnormality and enhancement centered on the L2-3 disc space is nonspecific and unchanged from prior. These findings may represent disc degeneration or mild infectious involvement.