Male, 67 years old, history of metastatic prostate cancer, with L2 compression fracture. Assess for metastases. Thoracic:Artifact from orthopedic hardware obscures the T11 and T12 vertebral bodies. Elsewhere, no concerning marrow replacement is seen. A region of T2 bright and mildly T1 bright signal within the T7 vertebral body probably represents a hemangioma.The spinal cord shows normal signal intensity and morphology throughout. No areas of significant spinal canal stenosis seen. The intervertebral disks are preserved. No significant foraminal narrowing is detected.Lumbar:Artifact from orthopedic hardware obscures the L1 vertebral body.A compression deformity of the L2 vertebral body is seen with up to 60% loss of height. This occurs in the context of a broad region of abnormal marrow replacement involving the entirety of the L2 vertebral body. On older lumber spine exams, there was evidence of a smaller region of marrow replacement at this site which has grown progressively over time.Elsewhere, no new areas of progressive marrow replacement are seen.As on prior examinations, the dura is thickened dorsally. Interposed between the dura and the cauda equina, multiple T2 hyperintense fluid collections are redemonstrated, predominantly situated dorsally and dorsolaterally extending throughout the lumbar spine region. Although these have changed slightly in conformation, they are not significantly increased in overall size.These collections contribute to a crowding of the cauda equina nerve roots which is similar to that noted previously. The visualized conus is unremarkable.L1-L2: Progressive loss of disk height and some disk bulging perhaps related to compression of the L2 vertebral body. The spinal canal is narrowed due to the intrathecal collections as above. Foramina are patent. L2-L3: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged.L3-L4: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged.L4-L5: Mild to moderate diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy, which have increased since the previous exam. Intrathecal fluid collections result in central spinal stenosis, which is unchanged. Mild bilateral neural foramina narrowing.L5-S1: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged. Mild neural foramina narrowing, left greater than right.
1.A new compression deformity is evident at L2 at the site of a previously seen suspected metastatic deposit. There is approximately 60% loss of vertebral body height but no significant bony retropulsion.2.Elsewhere, no new or concerning areas of marrow replacement are seen. The remaining vertebral bodies demonstrate preservation of height.3.No significant spinal canal or neuroforaminal stenosis in the thoracic spine.4.Degenerative disk disease, and persistent subarachnoid or subdural collections in the lumbar region, contribute to multilevel spinal canal stenosis and crowding of the cauda equina, not significantly changed from prior.