Reason: Hx of right breast cancer in 2008 (ER+, node+). Left breast cancer that was HER2+, node+ left breast cancer, s/p neoadjuvant therapy and lumpectomy/SLNBx \T\ XRT. Currently on exemestane History: new rib pain, now with vertebral body sclerosis at C4 concerning for metastasis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is 5 mm anterolisthesis C7 on T1. There is some loss of normal lordosis with mild reversal involving the upper cervical spine. No destructive osseous lesions or abnormal enhancement involving the vertebral bodies to suggest metastatic disease is appreciated. No suspicious enhancement within the spinal canal is definitively appreciated. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below, advanced at the C7-T1 level:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis. C4-5: Bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C5-6: Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Bilateral uncovertebral hypertrophy and small disc osteophyte complex. There is moderate to severe left and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis.C7-T1: Advanced degenerative changes with anterolisthesis with disc uncovering and extrusion. There is moderate spinal canal stenosis at this level including mild impression on the cord without cord signal abnormality. Advanced facet arthropathy is noted bilaterally. There is abnormal enhancement surrounding the facet joints, extending into the neural foramen bilaterally, as well as the epidural space, all favored to be on a degenerative basis. There is minimal right and moderate left neural foraminal stenosis.
1. No convincing evidence of metastatic disease in the cervical spine. No suspicious lesion is seen corresponding to the C4 sclerosis seen on recent cervical radiographs and was most likely on a degenerative basis.2. Advanced degenerative changes at the C7-T1 level with grade 1 to grade 2 anterolisthesis and advanced bilateral facet arthropathy. There is abnormal paraspinous soft tissue enhancement at this level extending into the epidural space which is likely on a degenerative basis. There is moderate spinal canal stenosis at this level with mild impression on the cord, without cord signal abnormality. Additional levels as above.