 Alignment of the lumber spine is anatomic. The vertebral body heights are grossly preserved without evidence of fracture. There is infiltrative marrow abnormality involving all lumbar vertebral bodies and the visualized T11-12 vertebral bodies with slight increase in the right aspect of L1 and L2. At the level of L4, there is circumferential epidural enhancing soft tissue abnormality with mild to moderate central spinal stenosis, similar to the prior exam. Additionally, there is epidural tumor at the level of L3, eccentric to the left, which effaces the posterolateral aspect of the thecal sac and extends into the left lateral recess, unchanged. There is a large soft tissue mass with osseous destruction of the left iliac bone extending into the ipsilateral sacroiliac joint, unchanged.
Widespread metastatic disease involving the vertebrae, epidural space, and left iliac bone; stable to minimally progressed since prior. Extent of epidural disease is not significantly changed in the interval with mild to moderate spinal canal stenosis at L3 and L4 again seen. 