Back pain, fever. Rule out abscess. Patient refused post contrast imaging which limits evaluation. There is severe loss of disc height at the L4-L5 level with mild residual edema. Bone marrow edema involving the L4 and L5 vertebral bodies is markedly improved. There is mild T2 hyperintensity involving the L5-S1 disc space which is grossly similar to prior and nonspecific. No discrete epidural or paraspinous fluid collection is appreciated, with lack of contrast limiting evaluation for small abscesses.There remains severe spinal canal stenosis at the L4-L5 level which is on a degenerative basis with disc osteophyte complex, ligamentum flavum thickening, and prominence of the epidural fat. There is also moderate to severe bilateral, left worse than right, neural foraminal stenoses. Spinal canal stenosis is to a moderate degree at the L3-L4 level with also mild bilateral neural foraminal stenosis at this levelVertebral body heights are maintained. Straightening of the lumbar spinal curvature is again seen. Paraspinous edema is again seen, which although overall improved is interval increased at the left posterior paraspinous left L1 to L3 levels.
1. Since 3/5/2016 there is an marked improvement in edema involving the L4 and L5 vertebral bodies and L4-L5 intervertebral disc space. Residual signal abnormality at the L4-L5 disc level may represent sequela of prior discitis-osteomyelitis, although residual infection cannot be entirely excluded. No new level of discitis-osteomyelitis is definitively appreciated. There is however interval increase in edema involving the posterior paraspinous musculature at the left L1 to L3 levels, which while nonspecific may be related to infection. No large paraspinous fluid collections are appreciated within the limits of noncontrast imaging.2. Severe spinal canal stenosis and moderate to severe neural foraminal stenosis are not significantly changed the L4-L5 level.