Findings:
Redemonstrated extensive destructive changes at L4-L5 consistent with discitis osteomyelitis. There is a prevertebral abscess and phlegmon which extends into the bilateral psoas musculature. There is also an extensive anterior epidural abscess extending from the level of the inferior L3-L4 interspace to the level of the mid S2 sacral segment. The anterior epidural component measures approximately 1.1cm in diameter and exhibits significant canal narrowing with mass effect on the nerve roots of the cauda equina. The abscess extends posteriorly along the right lateral aspect of the spinous processes and into the right greater than left paraspinous musculature. This portion of the abscess measures approximately 3.6cm x 1.3cm. There is increased signal enhancement within the L4-L5 spinous processes with erosive changes of the superior aspect of the L5 process consistent with osteomyelitis. There is phlegmon/edema extending into the superficial soft tissues of the lower lumbar spine. Otherwise, there are minimal degenerative changes of the lumbosacral spine. There are T2 bright ovoid structures in the bilateral periaortic regions likely reflecting lymph nodes.

Impression:
Discitis/osteomyelitis at L4-L5 with epidural abscess extending along the spinous processes and into the right greater than left paraspinous musculature with osteomyelitis of the L4 and L5 spinous processes. There is also a prevertebral abscess extending into the bilateral psoas musculature.

Recommendations:
For your training purposes, recommendations are not included in this report.