Reason: Pt is a 57 y/o male with RCC, evaluate for recurrence, attention to L2 vertebrae History: RCC Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is anterior compression fracture present at L1. This is unchanged since the prior exam The conus medullaris on sagittal imaging is grossly intact. No enhancing lesions are appreciated within the lumbar spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level right more than left. There is a left paramedian disk protrusion at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level. This is unchanged compared to the previous examAt L3-4 there is a left lateral recess disk protrusion at this level which encroaches on the nerve roots of the left lateral recess and is unchanged since prior exam. There is bilateral facet hypertrophy at this level as well as some ligamentum flavum hypertrophy. There is loss of disk space height, disk desiccation and diffuse disk bulge 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 a compression fracture present at L1 which is stable compared to the prior exam.2.Multilevel degenerative changes are present in the lumbar spine with encroachment of the nerve roots at the left lateral recess at L3-4 due to a disk protrusion. This is stable compared to the prior exam.3.No evidence for lumbar spine metastases