Back pain and radiculopathy. Compression fracture of L1. Patient had fall in 2015. Evaluate if compressing nerve roots. Also question of malignancy in the lumbar spine, for which postcontrast imaging requested. Five lumbar type vertebral bodies are presumed to be present. There is a compression fracture involving the L1 vertebral body with approximately 60% loss of height and grossly similar to prior chest CT dated 3/8/2016. There is mild degree of bone marrow edema as well as a small fluid containing cleft along the superior fractured endplate. There is mild osseous retropulsion which was also evident on prior CT. Remainder of the vertebral body heights in the lumbar spine are maintained. There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. No suspicious osseous lesions are appreciated. Conus terminates at the mid L2 level.Partially imaged thoracic spine on the sagittal images demonstrates a disc bulge at the T10-T11 level with mild to moderate spinal canal stenosis.Multilevel degenerative changes are seen, with individual levels as described below:T12-L1: Osseous retropulsion related to the compression fracture with moderate degree of spinal canal stenosis without frank compression of the distal cord at this level. There is mild to moderate degree of bilateral neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild narrowing of the spinal canal in its lateral aspects related to prominence of the epidural fat. Otherwise there is no significant spinal canal or neural foraminal stenosis. No significant disc disease.L3-L4: There is up to moderate degree of spinal canal stenosis, primarily involving the lateral aspects of the spinal canal related to prominence of the epidural fat. There is no significant disc disease. Neural foramina are patent. L4-L5: There is severe spinal canal stenosis at this level related to anterolisthesis, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis. Moderate disc height loss with fatty endplate marrow signal changes.L5-S1: There is moderate to severe disc height loss with fatty endplate marrow signal changes. Otherwise no significant disc bulge. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.
1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is severe spinal canal stenosis. Additional levels as detailed above.2. L1 compression fracture with approximately 60% height loss appears similar to prior CT from 3/8/2016. There is residual marrow signal edema. There is osseous retropulsion with associated moderate degree of spinal canal stenosis as well as mild to moderate degree of bilateral neural foraminal stenosis at the T12-L1 level.3. No suspicious lesions within the spine to suggest neoplasm.4. Grade 1 degenerative spondylolisthesis at L4-L5.