Metastatic lung cancer, C7 and T1 symptoms. Cervical Spine:Again seen is metastatic lesion involving the C7 vertebral body with diffuse marrow infiltration. There is associated lytic changes which are better appreciated on CT. Noted is expansion and extension into the left pedicle, transverse process, facets as well as the spinous process. There is mild diffuse loss of height of the C7 vertebral body similar to prior. There is moderate to severe narrowing of the left C7-T1 neural foramen which was present previously but appears slightly worse. Abnormal signal involving the inferior articular facet of C6 on the left is again seen.Craniovertebral junction appears within normal limits. There is mild diffuse loss of C7 height, vertebral body heights are otherwise maintained. Alignment remains unchanged since 4/6/2015 with loss of normal cervical lordosis. No abnormal signal seen within the cervical cord.Individual levels as below:C2-3: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy with no significant spinal canal or neural foraminal stenosisC4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing mild to moderate spinal canal stenosis. There is minimal left neural foraminal narrowing. No significant right foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild to moderate spinal canal stenosis particularly on the left. Mild left neural foraminal stenosis.C6-7: Disk osteophyte complex causing mild spinal canal stenosis. There is moderate to severe left neural foraminal stenosis which appears worse since 4/6/2015.C7-T1: Vertebral body metastasis extending into the posterior elements left greater than right causing moderate to severe left neural foraminal stenosis. There is mild right foraminal narrowing on a degenerative basis.There is minimal epidural soft tissue thickening and enhancement at the left ventral C7-T1 level suspected to represent minimal epidural tumor. There is no significant spinal canal stenosis associated with the epidural tumor. Thoracic Spine:Multiple metastatic lesions are seen in the thoracic spine. Small lesion is noted in the right posterior aspect of the T2 vertebral body. There is a lesion noted within the dorsal T3 vertebral body extending into the posterior elements. Small lesion is seen at T6. There is a lesion at T8 on the right which extends into the posterior elements. Small lesions are seen at T9 and T10. There is a larger lesion involving the T11 vertebral body extending into the posterior elements with expansion of the right pedicle and transverse process and infiltration of the adjacent rib. Small lesion is seen involving the inferior right T12 vertebral body.Vertebral body heights are maintained. No evidence of compression fractures. No significant spinal canal stenosis is demonstrated. Moderate right T10-T11 and mild right T11-T12 neural foraminal stenosis is seen related to tumor involving the posterior elements at T11. There is also mild right T8-T9 neural foraminal stenosis. Minimal epidural enhancement along the dorsal aspect of the lower thoracic spine is favored to be vascular. No convincing evidence of epidural tumor is appreciated. No cord signal abnormality. Abnormal marrow signal involving the ribs at multiple levels is also noted.
1. Vertebral body metastasis at C7 extending into the posterior elements on the left and to a lesser degree on the right is not significantly changed in size since 4/6/2015. There is minimal ventral epidural enhancement dorsal to the C7 level which is suspected to represent minimal epidural tumor. There is moderate to severe left C6-7 and C7-T1 neural foraminal stenosis which appears slightly worse in the interval.2. Multiple metastatic lesions throughout the thoracic spine without evidence of compression fracture. Several lesions extend into the posterior elements and narrow the neural foramina as detailed above particularly on the lesions at T8 and T11. No significant spinal canal stenosis in the thoracic spine. No definite evidence of epidural tumor in the thoracic spine.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7.