History of diskitis/osteomyelitis of cervical and lumbar spine: back pain. Cervical Spine: There has been interval decrease in the degree of enhancement within the C3 and C4 vertebrae, with resolution of the disc-space fluid collection and the associated epidural and prevertebral soft tissue thickening and enhancement. There is loss of the disc space height at C3-4, as well as perhaps slight low of height of the C4 vertebral body. There is unchanged mild anterior wedging of the C7 vertebral body. There is no spondylolisthesis. There is moderate to severe spinal canal stenosis at C4-5, mild spinal canal stenosis at C5-6, as well as moderate to severe spinal canal stenosis at C6-7 and C7-T1 associated with disc-osteophyte complexes superimposed upon a mild congenitally narrow spinal canal. There is mild bilateral neural foraminal stenosis at C3-4, severe bilateral neural foraminal stenosis at C4-5, moderate to severe bilateral neural foraminal stenosis at C5-6, and mild to moderate bilateral neural foraminal stenosis at C6-7. Apparent linear high T2 signal throughout much of the cervical spinal cord depicted on the sagittal images may be artifactual, since there is no convincing correlate on the axial images. There is patchy T2 hyperintensity in the pons, which may be related to chronic small vessel ischemic disease.Lumbar Spine: There is interval increase in the extent of the enhancement within the L2 and L3 vertebrae and intervening disc space, as well as mildly increased epidural swelling and enhancement at these levels. Furthermore, there is interval increase superior L3 and inferior L2 endplate irregularity and loss of height of these vertebral bodies, with 5 mm of retrolisthesis of L2 on L3 and mild to moderate spinal canal stenosis. In addition, abnormal enhancement extends into the anterior L3-4 disc space and anterosuperior portion of the L4 vertebral body. There also appears to be increase in the degree of enhancement within the anterior L5-S1 disc space and adjacent endplates. However, there are decreased fluid collections in the bilateral psoas muscles, measuring up to 9 mm on the left and 6 mm on the right, along with slightly decreased surrounding diffuse soft tissue enhancement. An intravertebral disc herniation in the inferior L4 endplate with associated enhancement is unchanged. Other manifestations of multilevel degenerative spondylosis in the lumbar spine are also unchanged. The spinal cord and cauda equina nerve roots are unremarkable. The left kidney is atrophic.
1. Interval improvement of findings related to discitis-osteomyelitis at C4-5.2. Interval increase in the extent of inflammatory changes with erosions in the L2 and L3 vertebrae, intervening disc space, and epidural space, as well as extension into the anterior L3-4 disc space and anterosuperior portion of the L4 vertebral body, and increased enhancement within the anterior L5-S1 disc space and adjacent endplates, which may be infectious or degenerative in nature. However, the bilateral psoas abscesses at L2-3 have decreased in size.3. Decreased fluid collections in the bilateral psoas muscles, measuring up to 9 mm on the left and 6 mm on the right, along with slightly decreased surrounding diffuse soft tissue inflammation. 4. Unchanged multilevel degenerative spondylosis in the cervical and lumbar spine.