Clinical question: The spinal abscess. Signs and symptoms: Acute lower back pain; fever. Pre-and post-enhanced MRI:Examination demonstrates increased T2/T2 stir signal intensity of disk space at L5 -- S1 level which is more pronounced anteriorly. There is moderate degenerative disk disease at this level with loss of disk height and with mild grade 1 anterolisthesis. There is enhancement of the intravertebral disk at this level corresponding to T2 hyperintense signal abnormality. This enhancement minimally expands into the prevertebral soft tissues anterior to disk. There is very subtle associated T2/T2 stir hyperintense endplate signal change with this finding however with questionable evidence of enhancement. Constellation of above findings are highly suspected for diskitis however without an abscess formation. The enhancement does not reach the dorsal aspect of the disk and there is no detectable extension into the spinal canal/epidural space. There is no evidence of central spinal stenosis at this level however moderate bilateral neural foraminal compromise secondary to degenerative changes are identified.Post enhanced images also demonstrate expected subtle enhancement of the hypertrophied changes of the facets and the ligamentum flavum in the lower lumbar spine. This appearance is an expected finding and not secondary to infectious process.T12 -- L1, L1 -- L2 and L2 -- L3 levels demonstrate degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy, no spinal stenosis or neural foraminal compromise.L4 -- 5 demonstrate moderate disk disease and loss of disk height, moderate to severe (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes at this level results in mild grade 1 anterolisthesis however without central spinal stenosis. Mild to moderate right neural foraminal compromise secondary to asymmetric right-sided facet hypertrophic changes is noted.
1.Increased T2/T2 stir signal intensity in the L5 -- S1 disk space with enhancement is suggestive of diskitis. Very subtle similar central changes of the adjacent endplates with enhancement is also noted. There is no evidence of prespinal soft tissue abscess formation or any detectable abnormal signal or enhancement in the spinal canal/epidural space to suggest an abscess. No central spinal stenosis.2.There is expected subtle enhancement of hypertrophied bilateral facets and ligamentum flavum in the lower lumber spine.3.Normal signal intensity and caliber of the cord, conus and the cauda equina without abnormal enhancement4.No evidence of central spinal stenosis at any level.5.Neuroforaminal compromise as detailed per level.