 The ventral epidural soft tissue thickening that was seen in the previous study along the L5 and S1 vertebral bodies is still visualized and slightly increased in size from 11.5 mm in previous study to approximately 13-14 mm currently. The immediate prior exam was obrained without contrast, but on comparison to the initial study, the enhancement is more uniform and solid. Only a single small locule of fluid is seen on the present exam within the enhancing tissue.There is a slight increase in the degree of retrolisthesis of L5 on S1 than the previous study and the L5-S1 disk space has progressively lost height. The L5 and S1 vertebral bodies are also more intensely enhancing with increased T2 signal abnormality. The spinal canal remains significantly narrowed by the epidural process at L5-S1 but similar to the prior exams.Ventral epidural thickening extends superiorly to the L4-L5 disc space with some enhancement within the L4-5 disk peripherally, but this finding is unchanged.There are irregularities of the anterior inferior vertebral body L3, related to degenerative changes and are stable since the previous study.No new disc space or vertebral body involvement.Inflammatory changes are seen in the anterior paraspinal soft tissue along L5 and S1, not significant changed since the previous study.There are mild to moderate degenerate changes seen, unchanged. The visualized spinal cord and conus are unremarkable.
1. Since previous studies the ventral epidural thickening along L5-S1 is slightly increased in size with progressive uniform pattern of enhancement and small persistence loculation of fluid. The spinal canal remains in this area significantly narrowed. The thickened soft tissue may represent expected granulation in the context of resolving epidural infection.2. Progressive destruction of the L5-S1 disc and progressive signal abnormalities and enhancement of the vertebral bodies L5 and S1. This possibly of ongoing or even progressive osteomyelitis cannot be excluded. It should be noted, though, that the changes seen on imaging in osteomyelitis can lag behind the clinical improvement by several months or more. Correlation with the clinical and laboratory parameters is recommended to interpret this finding.3. No evidence of infectious involvement of any new disc or vertebral body levels.