55-year-old male with back pain and severe sepsis. Please evaluate for epidural abscess. The exam is limited by motion. No epidural fluid collections are visualized. Five lumbar type vertebral bodies are present. Diffuse signal abnormality within the vertebral bodies is consistent with heterogeneous bone marrow from multiple myeloma involvement. At L2 the retropulsion from compression fracture continues to measure 5 mm and there is moderate effacement of the anterior thecal sac. Vertebral body height is unchanged. Kyphoplasties of T11, L1, and L4 are again seen. The conus appears to terminate at the L1 level.Individual levels are described below:T12-L1: There is a moderate disc bulge with bilateral facet and ligamentum flavum hypertrophy.L1-L2: Ligamentum flavum thickening and bilateral facet hypertrophy are present. There is a left foraminal disc protrusion.L2-L3: There is retropulsion of the L2 vertebral body measuring 5 mm with mild disc bulge with biforaminal prominence. Facet and ligamentum flavum hypertrophy are present. There is a moderate central spinal canal stenosis and mild-to-moderate bilateral neuroforaminal stenosis. L3-L4: Ligamentum flavum and bilateral facet hypertrophy causing mild spinal canal narrowing. There is mild left and mild-to-moderate right neural foraminal stenosis.L4-L5: Ligamentum flavum and bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: There is a left paracentral disc protrusion that causes posterior displacement of the descending left S1 nerve root. Paraspinous soft tissues are within normal limits.
1. No large epidural fluid collections are seen. 2. Diffuse degenerative changes as described in detail above including retropulsion of the L2 vertebral body with moderate central spinal canal stenosis.3. Left paracentral disc protrusion at L4-5 that causes posterior displacement of the descending left S1 nerve root. 4. Diffusely abnormal marrow signal which is unchanged, and likely related to history of multiple myeloma.