 Examination is limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent but decrease in diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy/degeneration superimposed upon edema. There are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and more prominent than prior.
1. Lack of contrast again limits evaluation. Compared to 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis and associated compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 2. Mild interval decrease in edema involving the bilateral psoas musculature. Otherwise signal abnormality involving the iliopsoas and paraspinous musculature is not significantly changed and compatible with edema and possible superimposed atrophy/degeneration. Focal areas of low T1 and T2 signal involving the bilateral psoas musculature corresponding to sites of previously seen abscesses may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. No new or enlarging fluid collections or worsening marrow or disc signal abnormalities to suggest progression of infection. 3. Clumping of the cauda equina nerve roots, which appears more prominent than prior, and consistent with arachnoiditis.  