Diagnosis: Disease of spinal cord, unspecifiedClinical question: history of T8-T11 laminectomy for intramedullary lesion done in 1985Signs and Symptoms: c/o right leg numbness and tingling MRI thoracic spine:There is a heterogeneous signal intensity mass at the surgical site along the posterior elements at the T8 and T9 laminectomy sites. It is predominantly bright signal on T2 and heterogeneously bright signal on T1. It appears to enhance following gadolinium administration. It has a cystic appearing component on its superior aspect. It is associated with osseous bridging at the laminectomy site predominantly posterior to this lesion but also anterior to it along the superior and inferior aspects of this lesion.There is distortion of the spinal cord and widening and focal thickening of the spinal cord at the T8 and T9 vertebral body levels where measures up to 18 x 5 mm axial dimensions. There is no abnormal enhancement appreciated within the thoracic spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a centimeter-sized focus of marrow replacement along the superior posterior aspect of the L1 vertebral body without associated contrast enhancement which is low signal on T1 and T2 imaging.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minor disc bulge associated with some disc desiccation at this level. There is a focal signal hyperintensity along the annulus of the disc posteriorly at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some loss of disc space height. There is mild ligamentum flavum hypertrophy at this level.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.There is distortion and thickening of the spinal cord at the T8 and T9 vertebral levels. It's possible this is related to post surgical change. Comparison to prior exams and/or follow-up exam would help further evaluate this for possible residual neoplasm.2.There is soft tissue lesion present along the posterior elements at the laminectomy sites which bulges into the spinal canal. One possibility is that this may represent postsurgical growth related to laminectomy and osseous bridging. Even though it does not have a general appearance of a meningioma, meningioma is a common extra-axial mass and thus the possibility cannot be excluded.3.There are some degenerative changes present in the lumbar spine.4.A small L1 vertebral body lesion is of unclear significance.