Clinical question: cord compressionSigns and Symptoms: LE weakness Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is diffuse marrow replacement present associated with patchy enhancement of the lumbar vertebrae and the visualized sacrum. There is redemonstration of epidural fat accumulation within the lower lumbar spine and sacral spinal canal.There is a posterior convex bulging of epidural lesion into the spinal canal at L4 and L5 which was also present on the prior exam. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy redemonstrated at this level associated with a diffuse disc bulge and effacement of the fat surrounding the exiting nerve roots within the left neural foramen There is mild anterior subluxation of L5 on S1 which is stable compared to the prior exam. There is effacement of the CSF within the thecal sac at this level and in the sacral spinal canal. There is epidural thickening present behind the L4 and L5 vertebral bodies which has progressed and is associated with narrowing of the spinal canal. The thecal sac appears to be narrowed in the CSF appears to be effaced within the distal thecal sac from the L3-4 disc space level inferiorly. Compared to the prior exam and epidural thickening and associated infiltration of the fat planes at the epidural space appears to have progressed. There is also effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level which is related to diffuse disc bulge and facet hypertrophy and was present on the previous exam as well. There is bilateral facet hypertrophy at L4-5 and L5-S1 which was previously presentAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Since the prior examination the patient has developed greater epidural thickening which narrows the distal thecal sac and effaces spinal fluid substantially at the L4 and L5 vertebral body levels and sacral spinal canal. This appears to represent infiltrating lesion within epidural lipomatosis. This results effectively in spinal stenosis at the L4 and L5 vertebral body levels as well as the sacral spinal canal.2.Diffuse skeletal metastases.3.Findings were discussed with the radiation oncology service.4.Findings were discussed with Dr Ansari.5.There is facet hypertrophy present in the lower lumbar spine.