Clinical question: Resolution of cervical diskitis and acute right osteomyelitis. Signs and symptoms: Cervical diskitis and vertebral osteomyelitis status post IV antibiotics. Pre-and post enhanced cervical MRI:Examination demonstrate interval complete resolution of T2 and T2 stir hyperintensity signal changes consistent with bone marrow edema of the vertebral bodies of C3 and C4. There is also no evidence of additional T2 hyperintensity of the intervertebral disk spaces. Trace faint enhancement of the disk space at C3 -- C4 is identified. There is no detectable abnormal epidural, leptomeningeal or perispinal soft tissue enhancement.Foramen magnum is unremarkable.C2 -- C3 demonstrate no spinal stenosis or neural foraminal compromise. C3 -- C4 demonstrate advanced disk disease with near complete loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes however results in flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, ventral hypertrophic changes and possible a central disk protrusion at this level results in significant mass effect and posterior displacement of the cord and central spinal stenosis. Significant bilateral neural foraminal compromise is also present. This appearance remains fairly similar to prior exam. There are punctate and linear foci of cord T2 hyperintensity similar to prior exam and consistent with cord myelomalacia. This finding is most noticeable at C4 -- C5 however it extends beyond this level.C5 -- C6 demonstrate mild to moderate disk disease and loss of disk height, broad-based bulging disk and a tiny central disk protrusion at this level results in significant flattening deformity and posterior displacement of the cord and moderate central spinal stenosis as well as significant bilateral neural foraminal compromise.C6 -- C7 demonstrate moderate to advanced disk disease and loss of disk height bulging disk and a central disk protrusion, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in significant bilateral neural foraminal compromise and moderate central spinal stenosis.C7 -- T1 demonstrate asymmetric right-sided moderate facet hypertrophic changes and moderate bilateral ligamentum flavum hypertrophy with resultant significant right neural foraminal compromise and no central spinal stenosis.Pre-and post enhanced thoracic MRI:Examination demonstrate normal anatomical alignment of vertebral column. There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges. Multi-level degenerative changes with tiny ventral hypertrophic change and bulging disks results in multilevel mild effacement of ventral subarachnoid space, however without evidence of spinal stenosis at any level. Mild neural foraminal compromise in mid to lower thoracic spine without significant change since prior exam.
1.Examination demonstrate interval resolution of bone marrow edema at C3 and C4 vertebral bodies without residual enhancement. Very subtle trace residual enhancement at C3 -- C4 disk level is detected. Cervical cord myelomalacia without interval change since prior exam as detailed. Very advanced degenerative changes of cervical spine with resultant multilevel significant central spinal stenosis and bilateral neural foraminal compromise as detailed per level above.2.Pre and post enhanced MRI of thoracic spine demonstrate no evidence of abnormal enhancement. No evidence of central spinal stenosis. Mild to moderate degenerative changes of cervical spine without significant change since prior exam as detailed above.