Images below are 10 months later, no intervention was performed.

Discogenic endplate changes

Findings:

Sagittal and axial MR images demonstrate extensive marrow edema signal involving L4 and L5, with a markedly narrowed L4-5 disc space. The L4 and L5 vertebral bodies demonstrate diffuse enhancement with minimal paravertebral signal abnormality. The L4-5 disc maintains low signal on all sequences and there is probable vacuum phenomenon. There is no definite endplate erosion or abnormal T2 signal within the disc space.

The follow up images demonstrate resolution of the marrow edema signal and development of fatty marrow conversion of the L4 and L5 vertebral bodies. The enhancement has nearly completely resolved. Reactive enhancement is associated with a Schmorl’s node deformity in the superior endplate of L5.

Discussion/Differential Diagnosis:

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