 Redemonstrated are postsurgical findings of the lower lumbar spine related to biopsy of a sacral spinal canal lesion and radiation therapy. There is decrease in size of the fluid collection within the operative bed, abutting the dura. There is an enhancing mass within the spinal canal at the S1 and S2 levels, which is stable to slightly decreased in size. There are multiple vertebral body compression fractures again noted, most severe at T12 with nearly 70% loss of height. There is slight progression of central collapse of the L2 vertebra. The compression deformities at L3 and L4 have not significantly changed. There is unchanged mild anterior wedge deformity of T11. The marrow signal of the lumbar vertebral body is heterogeneous with scattered subtle areas of enhancement. Fatty replacement of L5 and the sacrum is consistent with radiation change. The imaged spinal cord and conus are unremarkable. The nerve roots of the cauda equina disperse evenly up to the point of the sacral tumor where there is some clumping.L1-2: Mild disc bulge and unchanged small superimposed left paracentral disc extrusion with superior migration posterior to the L1 vertebra. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Mild facet and ligament flavum hypertrophy. Mild disc bulge. Unchanged prominent epidural fat contributes to mild generalized canal narrowing. Mild to moderate bilateral foraminal narrowing. L4-5: Postsurgical change. Moderate facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing. L5-S1: Postsurgical change. Moderate facet and ligament flavum hypertrophy. Mild disc bulge with a small superimposed central protrusion. No significant spinal canal stenosis. Minimal to mild bilateral neural foramen stenosis.
1. Stable to slightly decreased size of residual enhancing tumor within the sacral spinal canal.2. Multiple vertebral body compression deformities and scattered subtle abnormal marrow signal, which is compatible with known myelomatous disease and pathological fractures, which has mildly progressed at L2.3. Multilevel degenerative spondylosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.