53 years Female (DOB:5/1/1963)Reason: Discussed high priority of study (goal w/in 24 hours) with Neuro-Rad Fellow, Veronesi p3854. Please evaluate for abscess in spine, epidural space, paraspinal muscles as well as any interval change in osteomyelitis given recurrent fevers. History: as above PROVIDER/ATTENDING NAME: ANNA VOLERMAN BEASER ANNA VOLERMAN BEASER Cervical spine:The patient is status post anterior fusion using metal plate and screws at C4, C5, C6 and C7.The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based disc protrusion present at this level which impresses on the ventral aspect of thecal sac and is associated with hypertrophy of the ligamentum flavum. Overall there is a mild degree of spinal stenosis at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are some endplate osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are some endplate osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The patient status post laminectomies from T7 through T11. Since the prior exam the patient is developed destruction of the endplates at T8-T9. There is continued enhancement within the T7, T8 and T9 vertebral bodies. There is epidural enhancement present at the T7, T8 and T9 levels which is not changed in thickness anteriorly. Posteriorly the epidural enhancement is present at the levels of laminectomy however, spinal canal is not as narrow was on the prior exam. There is no spinal fluid can be identified ventral and posterior to the spinal cord. There is circumferential epidural thickening present at T7, T8 and T9 which appears to be worse at the T8 level and is predominantly on the left hemicanal. On the prior exam it appears that the spinal canal was smaller and narrowed down to approximately 6 x 6 mm whereas on the current exam than narrowest component spinal canal is approximately 10 x 7 mm. A fluid collection behind the thecal sac at the site of the laminectomy has a filled in with contrast enhancing tissue with the exception of a small component measuring 10 mm x 10 mm in axial dimensions.There is paravertebral soft tissue thickening and pleural thickening bilaterally but more on the right pleural space compared to the left. This was also present on the prior exam and has regressedThe thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Please note that counting from C2 there are 6 lumbar vertebrae present.The patient is status post posterior fusion including L5, L6 and S1 using pedicle screws at L5 and S1 bilaterally a and interconnecting rods. There is a disc spacer present at L6-S1 the one at L5-L6. There are associated reactive changes at the adjacent endplates. These is been present on the prior exam from 7/30/2016 and have not changed substantially.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L6-S1 there is no significant compromise to spinal canal or neural foramina.At L5-6 there is effacement of the fat at the lateral recess bilaterally with encroachment of nerve roots of the lateral recesses sees as well as mild narrowing of neural foramina. There is bilateral facet hypertrophy at this level as well as a disc bulge. Effacement of fat at the lateral recesses developed since the 5/18/2012 exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
Please note that there are 6 lumbar vertebrae present.1.Anterior fusion of the cervical spine, multilevel laminectomies in the midthoracic spine and anterior and posterior fusion in the lower lumbar spine as detailed above.2.Since prior exam with greater destruction of the T8-T9 endplates. This suspicious for discitis osteomyelitis.3.There is epidural thickening at the mid thoracic spine which has somewhat regressed relative to the prior exam but is worse at the T8-T9 level. There is continued evolution of postoperative changes at the laminectomy sites. The possibility this represents a regressing phlegmon cannot be excluded.4.The patient is undergone anterior and posterior fusion in the lumbar spine. Since prior exam there is greater encroachment of nerve roots at the lateral recesses at L5-L6 compared to the prior exam from 2012.5.There are degenerative changes present cervical spine worse at C3-4 without significant compromise spinal canal or neural foramina.6.Bilateral pleural thickening has regressed relative to the prior exam.