IVDU with difficulty mobilizing and lower limb weakness.
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Note is made of prior fusion of L2 and L3 vertebral bodies.
There is near complete collapse of L3 vertebral body, with destruction of the L3/L4 intervertebral disc and an irregular peripherally enhancing collection at the L3/4 intervertebral disc space. Marked irregularity of the L3 inferior endplate and L4 superior endplate is also demonstrated. There is partial collapse and diffuse abnormal signal/enhancement of the L2 and L4 vertebral bodies.
A focal kyphosis is demonstrated from L2-4 and there is abnormal enhancement extending within the anterior epidural space at L3/4, however, there is no discrete epidural collection. At L3/4, there is distortion of the thecal sac with moderate spinal canal stenosis and bilateral neural exit foraminal stenoses.
Extensive abnormal signal/enhancement is demonstrated within the prevertebral tissues and involves the right psoas muscle. The enhancement extends along the exiting right L3 and to a lesser extent L2 and L4 nerve roots. Diffuse interspinous enhancement is also demonstrated, with extension into both facet joints at L3/4.
Conclusion: Features are those of diskitis/osteomyelitis.
The patient underwent a biopsy that aspirated frank pus.