Male, 43 years old, with history of bilateral lower extremity paraplegia s/p gun shot wound, with more recent history of enterococcal MV endocarditis, now with sepsis, back pain and new fecal incontinence, assess for epidural abscess. The T11 vertebral body is compressed and deformed with mild osseous retropulsion. In addition, the T11-12 disc space is degenerated with fatty endplate signal change on both sides of the disc. There is mild endplate enhancement which is likely degenerative. No evidence of marrow edema is seen. No evidence of any paraspinal or epidural fluid collection is seen at the T11-12 level. These osseous findings are stable when compared to a prior MRI from 2014.The lower spinal cord is diffusely atrophic beginning at approximately the T7 level and continuing down to the level of the conus. Based on limited comparison with the prior lumbar MRI, this is unchanged. The distal cord is very thinned and deformed at the T11-12, but again, no epidural collections are seen.A large right anterior osteophyte is evident at L3-4 which has substantially increased in size from the prior exam. The osteophyte and adjacent vertebral body marrow are mildly edematous and there is enhancement within the osteophyte and the adjacent paraspinal soft tissues. However, no fluid collections are seen.Otherwise, spinal alignment is grossly anatomic and the remaining vertebral bodies demonstrate preservation of height. No other areas of concerning marrow replacement, edema or pathologic enhancement are seen. The right neural foramen at T11-12 is narrowed due to osseous deformities, but elsewhere, no significant spinal canal or foraminal stenosis is seen.
1.Chronic compression and osseous deformity of the T11 vertebral body, along with chronic degeneration of the T11-12 disc space, show no significant interval change when compared to a prior MRI from 2014.2.No evidence to suggest osteomyelitis-discitis or epidural abscess is seen at T11-12 or at any other level in the thoracic or lumbar spine.3.A large right anterior osteophyte is evident at L3-4 with edema and enhancement of the adjacent bone and paraspinal soft tissues. No discrete fluid collections are seen. These findings are favored to be inflammatory and likely reactive to the large osteophyte, with infection a less likely consideration.Findings were discussed with Dr. Cardin at 0930 on 6/3/16. 