Male, 47 years old, with history of L3-4 diskitis osteomyelitis with MRSA bacteremia. The L3-4 intervertebral disk demonstrates abnormal increased T2 signal with irregularity and patchy T2 hyperintensity of the adjacent end plates. Moderate ill-defined T2 hyperintensity is seen within the adjacent paraspinal soft tissues, including the psoas musculature. No discrete epidural or paraspinal fluid collections are seen. A few scattered mildly prominent para-aortic and aortocaval lymph nodes are seen.Mild T2 hyperintensity is seen within the T11-12 disk space. There are small Schmorl's nodes along the adjacent end plates as well as increased T2 signal along the T12 superior endplate. Please note that this level is assessed only on sagittal images.A scoliotic curvature of the lumbar spine is demonstrated. Vertebral bodies are otherwise well aligned. Aside from endplate irregularity at L3-4, vertebral body heights and morphology are maintained.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy. Loss of disk height and T2 signal with disk bulging asymmetric to the right. Moderate generalized spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe right and mild left foraminal narrowing. L3-4: Moderate facet hypertrophy with a small facet effusion on the left and peri-facet edema. Bulging disk resulting in a moderate generalized spinal canal stenosis. Severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with a small facet fusion on the right and peri-facet edema. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing.L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.
Constellation of findings at L3-4 including abnormal disk signal intensity, irregularity and abnormal signal intensity of the adjacent endplates, and edema/inflammation of the adjacent paraspinal soft tissues, compatible with diskitis osteomyelitis. No definite discrete or drainable epidural or paraspinal collections are seen, though sensitivity for this is somewhat reduced without IV contrast. Peri-facet edema at L3-4, and to a lesser extent at L4-5, may be degenerative in nature, but the possibility exists that the posterior elements are also involved with infection.Mild abnormal signal of the T11-12 disk with some evidence of endplate edema at T12 could be degenerative, but the possibility of osteomyelitis diskitis must be considered at this level as well.Degenerative disk disease and posterior element hypertrophy result in a moderate generalized spinal canal stenosis and significant right neuroforaminal narrowing at L2-3. Abnormalities of the disk and posterior elements at L3-4 contribute to a moderate generalized spinal canal stenosis and significant neuroforaminal narrowing.