Diagnosis: Malignant neoplasm of lung. The patient has abnormal gait associated with lower extremity hyperreflexia.Clinical question: With a history of newly diagnosed lung cancer and unsteady gait, there is concern that the cause of the abnormal gait is related to spinal metastasis. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.There is a 6 x 5 mm sagittal dimension lesion present along the right posterior lateral aspect of the C5 vertebral body which is bright on T1-weighted imaging. This lesion is also bright on the T2 STIR image acquisitions. It is associated with some contrast enhancement.No abnormal enhancing lesions are identified in the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which mildly narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. There are some endplate reactive changes at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There is a mass present in the right lung measuring approximately 5.7 cm in diameter
1.There is no convincing evidence for metastatic disease to the cervical or thoracic spinal cord or the cervical or thoracic spine. A lesion within the C5 vertebral body most likely represents a vertebral body hemangioma.2.There is a mass in the right lung. Please refer to chest CT from 6/19/2015 for further comments.3.There are degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is encroachment of the exiting nerve roots within the neural foramina due to uncovertebral osteophytes.