Female, 73 years old, with history of recurrent ovarian cancer and worsening right low back pain. Assess for spinal metastases, osseous abnormality, or disc abnormality. Spinal alignment is anatomic. Vertebral body heights are preserved. Uniform fatty marrow replacement from L2 down is likely related to radiation therapy.Schmorl's nodes are seen along the L3-4 endplates. More anteriorly along the L3 inferior endplate, there is a T1 hypointense, T2 heterogeneous mildly enhancing lesion which is nonspecific. Mild associated sclerosis is seen on prior CTs dating back at least to 2/19/2014.Aside from these findings, no other concerning areas of marrow signal abnormality are detected.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.Mild loss of disc height affects L3-4 and L4-5. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a superimposed right foraminal protrusion. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. L3-4: Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Marked right facet hypertrophy. Mild left facet hypertrophy. Ligamentum flavum thickening. Mild laterally bulging disc. No significant spinal canal stenosis. No significant neuroforaminal narrowing. A right retrocrural pathologic lymph node is identified. Left renal pelvocaliectasis is also redemonstrated.
1.No definite evidence of spinal metastatic is seen. A nonspecific lesion within the anterior aspect of the L3 vertebral body showing heterogeneous T2 signal characteristics and mild enhancement seems to have been present at least as far back as early 2014. This could represent a benign lesion such as a hemangioma. Given the history of malignancy, though, at least one follow-up exam demonstrating stability would be reassuring.2.A disc herniation at L2-3 on the right causes a moderate narrowing of the right neural foramen.3.Marked right facet arthropathy is seen at L5-S1.4.No areas of high-grade spinal canal or foraminal stenosis are seen.