 For the purposes of this dictation, the last well formed disk space is referred to as L5-S1. There is motion degradation limiting evaluation. Further, due to low GFR, patient was unable to receive IV contrast which further limits evaluation. Given these limitations, there is a 28 x 33 mm expansile heterogeneously T2 hyperintense and T1 hypointense mass in the spinous process, lamina and pedicles of the L1 vertebral body with 5 mm thick posterior epidural tumor extending superiorly up to the mid T12 level. There is diffuse heterogeneous low T1 osseous marrow signal consistent with osseous metastatic disease.The conus appears to terminate at superior aspect of L2, however this is limited by motion artifact. There is ventral displacement of the conus and the cauda equina nerve roots without significant edema within the conus. There is additional T2 hyperintense signal abnormality in the L4 spinous process as well. There are numerous scattered low T1 and high T2 signal lesions in the sacrum and bilateral iliac bones, again consistent with osseous metastases.There is mild grade 1 retrolisthesis L2 on L3, mild anterolisthesis of L4 on L5 and L5 on S1. There is disk desiccation at all levels in the lumbar spine with severe loss of disk height at L2-3. There is mild diffuse posterior epidural lipomatosis which contributes to minimal narrowing of the spinal canal diffusely.T12-L1: Diffuse disk bulge with no significant spinal stenosis.L1-2: Diffuse disk bulge and left far lateral disk protrusion with posterior epidural tumor causing mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis secondary to expansile tumor in the pedicles of L1.L2-3: Diffuse disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing no significant spinal canal stenosis and moderate bilateral neural foraminal stenosis.L3-4: Diffuse disk bulge and moderate bilateral facet arthropathy with ligament flava thickening causing mild right and moderate left neural foraminal stenosis with no significant spinal canal stenosis.L4-5: Diffuse disk bulge asymmetric to the right, and severe bilateral facet arthropathy with ligament flava thickening causing moderate right and mild left neural foraminal stenosis with no significant spinal canal stenosis.L5-S1: Diffuse disk bulge asymmetric to the right with bilateral facet arthrosis and ligament flava thickening causing severe right and mild to moderate left neural foraminal stenosis. Disk material encroaches upon the bilateral subarticular zones (right greater the left) without significant subarticular zone stenosis.
1.Diffuse osseous metastatic disease, with prominent expansile tumor in the L1 posterior elements extending into the posterior epidural space causing mild spinal canal stenosis at this level.2.Lumbar spondylosis as described above.3.Findings were discussed with the clinical service by the radiology on call resident at time of initial interpretation.