Clinical question: Patient with metastatic melanoma. Signs and symptoms: Numbness, weakness bilateral lower extremities (left greater than right). Pre-and post-enhanced lumbar MRI:This examination extends from T10 inferiorly through S3 and demonstrates no evidence of osseous or leptomeningeal enhancement.Lower most visualized thoracic spine and thoracic cord is unremarkable with the exception of mild degenerative changes.T12 -- L1 demonstrate moderate disk disease and loss of disk height without spinal stenosis or neural foraminal compromise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foramina compromise.L2 -- L3 demonstrate mild degenerative changes and unremarkable otherwise.L3 -- L4 demonstrate mild disk disease and loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Mild to moderate left neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy, mild bilateral widening of the facet spaces and with facet effusion. There is mild central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate moderate to advanced disk disease and loss of disk height, mild to moderate the right and mild left facet and ligamentum flavum hypertrophy. There is a central and left lateral disk protrusion projecting into the ventral epidural space with resultant left lateral recess compromise. No central spinal stenosis. Degenerative changes at this level results in significant (left greater than right) neural foraminal compromise.Unremarkable paraspinal soft tissues.
1.No evidence of osseous or leptomeningeal metastases.2.Mild-to-moderate degenerative changes of disks and the posterior elements with resultant mild central spinal stenosis only at L4 -- L5 level.3.Multiple levels of neural foramina compromise more significantly at L5 -- S1 bilaterally.4.Disk protrusion at L5 -- S1 with resultant mild left lateral recess compromise.