Diagnosis: Dorsalgia, unspecified. Other chronic painClinical question: rule out abscess, osteoSigns and Symptoms: pain, imaging findings of osteo Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior fusion at L3-4, L4-5 and L5-S1 associated with bilateral pedicle screws at L3, L4, L5 and S1. Patient is status post laminectomies at L4 and L5. There is anterior wedging of the L3 vertebral body. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. These findings are stable compared to the August exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level associated with effacement of the fat surrounding the exiting nerve roots within the neural foramina. The endplates are irregular at this level and there is mild anterior subluxation of L4 and L5. There are endplate reactive changes present which are bright on T1. These findings are stable compared to the August 2015 exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.There is mild anterior subluxation of L3 and L4. There is ligamentum flavum hypertrophy present at this level as well as facet hypertrophy. At L2-3 there is a large left lateral recess disc extrusion present with disc material extending behind the L2 and L3 vertebral bodies and compressing the thecal sac and effacing spinal fluid surrounding the nerve roots of the cauda equina at this level. On sagittal imaging the disc extrusion measures approximately 26 x 11 mm sagittal dimensions. There is also a left far lateral disc protrusion at this level which displaces the left-sided exiting nerve root after it exits the neural foramen. These findings are stable compared to the August exam. Since the prior exam, however, the adjacent vertebral arteries have the lower T1 signal and the endplates are not readily visualized. Additionally, there is signal hyperintensity within the L2-3 disc space and which is new since the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.Examination is degraded by patient motion which may obscure more subtle abnormalities.There is atrophy of the left psoas muscle.A well-circumscribed T1 hyperintense 6 mm lesion is present in the right psoas muscle at the L2-3 disc space level. It is unclear whether this was previously present on the prior exam because the prior exam is degraded by patient motion.
1.There are inflammatory changes present at the L2-3 disc space level which were not as present on the prior exam from August 2015. The possibility of discitis and osteomyelitis should be considered.2.There is a large disc extrusion at L2-3 which creates significant spinal stenosis. These findings were also present on the August exam 2015.3.A 6 mm collection the right psoas muscle is of unknown significance.4.The patient is status post lower lumbar spine surgery as described above with posterior fusion and laminectomies.