Diagnosis: LumbagoClinical question: rule out diskitis, likely herniated diskSigns and Symptoms: low back pain, elevated esr, crp Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disk dessication present. There is mild fatty replacement along the paraspinous musculature.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication, diffuse disk bulge and mild to moderate facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved. There is contrast enhancement and T2 signal hyperintensity along the facet joints at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a 7mm focus of T2 hyperintensity associated with contrast enhancement at the posterior aspect of the L4 vertebral body at the inferior endplate adjacent to the disk annulus at the midline. There is loss of disk space height, disk dessication, diffuse disk bulge and a minor degree of facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication, a minor diffuse disk bulge and mild facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a minor diffuse disk bulge.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a minor diffuse disk bulge. There is some endplate reactive change present which is bright on T1 and dark of Fat sat imaging suggesting chronic stage.There is a 21x22mm right renal cystic lesion present most likely representing a simple cyst.
1.There is no evidence that is convincing for diskitis.2.There are multilevel degenerative changes present mostly in the chronic stage but in an acute/subacute stage at L4-5 (L4 endplate)and L5-S1 (facets) without compromise to spinal canal or neural foramina.