Male, 67 years old, with history of metastatic thyroid cancer with metastases to the bone, presenting with new right lower extremity paralysis and thoracic spinal tenderness. Evaluate for cord compression. Metastatic infiltration of the C2 and C3 vertebral bodies has progressed when compared to the two prior examinations. In particular, infiltration of the C2 vertebral body with osseous expansion is significantly progressed when compared to 9/15/2015 and perhaps mildly progressed when compared to 11/5/2015. This osseous expansion results in a significant degree of spinal canal narrowing with spinal cord impingement at the C2 level.Metastatic infiltration has also progressed at C7, T1, T2 and T3. The T1 and T2 vertebral bodies are newly compressed with a mild degree of retropulsion. The spinal canal canal is narrowed in this region and there is very likely some degree of cord impingement.Extensive surgical findings status post partial corpectomy of T6 and T7 are again seen with posterior instrumented fixation extending from T4 through T11. Artifact from the surgical instrumentation obscures visualization of the bones and spinal cord through this region. However there does appear to be a substantial quantity of infiltrative tumor within the left aspect of the residual vertebral bodies at T6 and T7 which appears larger than on prior exams.Heterogeneous marrow signal is seen within T12 and L1. The marrow is relatively more fatty replaced from L2 down. No significant expansile tumor is evident in the lumbar region. Degenerative endplate changes are seen most notably at L2-3 and at L4-5. However, no significant or high-grade spinal canal narrowing is suspected in the lumbar region due to either tumor or degenerative disease.A retropharyngeal effusion is seen similar to the prior examination. Prominent T2 hyperintensity is demonstrated within the pons which appears to have progressed from prior exams but this may be technical.
1.Progressive metastatic disease in the upper cervical spine, particularly affecting C2 which is expanded and which consequently causes a severe spinal canal narrowing and cord impingement at this level.2.Progressive metastatic disease in the upper thoracic spine with new compression deformities of T1 and T2, osseous retropulsion, and spinal canal narrowing with cord impingement.3.Although the mid thoracic region is obscured by metallic artifact, growing tumor is suspected adjacent to the corpectomy levels.4.No significant tumor related spinal canal stenosis is seen in the lumbar region.