Clinical question: History of spinal osteomyelitis c/b neutropenia on Oxacillin; assess for interval change. Signs and symptoms: Osteomyelitis assess for change. Pre and post enhanced lumbar spine MRI: Examination status post anterior fusion with maintained normal anatomical alignment similar to prior exam. There is evidence of placement of intervertebral disc spacers at L4-L5 and L5-S1 disc levels without change in the position or signal intensity.T2/T2 STIR hyperintensity of L4, L5 and S1 vertebrae are again demonstrated and without convincing evidence of interval change.On post enhanced images enhancement of L4, L5 and S1 vertebral bodies are again noted without significant change of their extent however the enhancement may be slightly less conspicuous since prior study.There is however interval decreased epidural thickening and enhancement posterior to L5-S1 and S2 levels since prior exam suggestive of interval improvement.Extensive spinal soft tissue thickening is again noted. Prevertebral soft tissue thickening with enhancement anterior to the vertebral body of L5 demonstrate interval improvement and measuring approximately 17 mm compared to prior study measurement of 25 to 28 mm. A vertically oriented long thin rim enhancing collection anterior to the vertebral bodies of L4 and extending inferiorly to L5-S1 disc level is again noted without convincing evidence of interval change. Finding is more likely to represent a postoperative postoperative change however possibility of an abscess cannot be entirely excluded.There is no evidence of spinal stenosis at any level and no detectable abnormal enhancement of the cord, conus or the cauda equina.
1.Postoperative changes of anterior fusion at the L4, L5 and S1 levels with stable normal anatomical alignment of vertebral column.2.Marrow signal T2/T2 STIR hyperintensity of L4, L5 and S1 levels demonstrate no significant change, however the enhancement appears slightly less conspicuous.3.There is noticeable interval decreased epidural thickening and enhancement posterior to the vertebral bodies of L5 through S2 since prior exam and interval decrease in prevertebral soft tissue thickening suggestive of interval improvement.4.A vertically oriented thin rim-enhancing lesion anterior to L4 to S1could represent post operative finding without interval change. Possibility of an abscess however cannot be entirely excluded.5.There is no detectable abnormal enhancement of the cord, conus or the cauda equina.