Metastatic base of tongue cancer, with known epidural tumor at T1-T5, presenting with increasing back pain and new 4/5 weakness in right quadricep. No urinary symptoms, normal rectal tone. Had kyphoplasty at T3 on 12/2. Evaluate for cord compression. There is multifocal narrowing of the spinal canal, most pronounced at the level of C3-4, in addition to indentation of the cord at T3-4 without evidence of acute cord compression. There are numerous osseous metastases throughout the spine, similar in extent as on the prior exam. There has been interval kyphoplasty of the T3 pathologic compression fracture, with persistent approximately 50% loss of height and apparent increased retropulsion inferiorly along the disc material, which mildly indents the spinal cord. No new pathologic fractures are identified. There are multiple epidural metastases, which do not appear significantly changed from the prior exam. Specifically, epidural tumor extends from T1 through T5 and is present at T10 and L2 with extension into the right neural foramina at these levels, as well as at S1 to S3. There is an intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina, which appears similar to the prior exam. There is multilevel degenerative spondylosis in the lower lumbar spine with associated minimal spinal canal and neural foraminal narrowing. There is edema within the upper thoracic and lower lumbar paraspinal muscles, perhaps related to denervation effects. There is partly imaged mediastinal and left axillary adenopathy.
1. Numerous metastases to the axial skeleton with epidural extension, particularly at in the upper thoracic region, with possible mild spinal cord compression and at T10 and L2 with associated neural foraminal narrowing, as well as at S1 to S3. However, the lack of contrast and axial images limit the assessment.2. Interval kyphoplasty of the T3 pathologic compression fracture with apparent increased retropulsion and indentation of the spinal cord.3. Intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina.4. Partly imaged mediastinal and left axillary adenopathy related to metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.