Male, 79 years old, with history of prostate cancer, under control with undetectable PSA on therapy, but with left increasing left leg sciatica, known L5 lesion on CT and bone scan. Trace retrolistheses are seen of L3 on L4, and L4 on L5. The normal lumbar lordosis is straightened.Vertebral body heights are preserved. The L5 vertebral body demonstrates heterogeneous low T1 and T2 signal which is compatible with the sclerotic lesion noted on prior CT and plain films, likely representing a metastasis. There is no edema or enhancement associated with this lesion, or elsewhere in the visualized lumbar vertebral bodies.The distal spinal cord and conus are unremarkable. The cauda equina nerve roots are also unremarkable except as discussed below. No pathologic intrathecal or epidural enhancement is seen.L1-2: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a superimposed right paracentral and subarticular disc extrusion extending below the disc space for approximately 10 mm. This causes effacement of the right lateral recess in addition to a generalized moderate spinal canal stenosis both neural foramina are moderately narrowed. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a left paracentral and subarticular disc extrusion extending below the disc space for 10 mm. Severe encroachment of the left lateral recess and a moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate to severe left and mild right foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Moderate to severe left and moderate right foraminal narrowing.
1.Signal abnormality is evident within the L5 vertebral body compatible with a known sclerotic metastasis. Lack of edema and enhancement would suggest that this is a quiescent treated lesion.2.No additional areas of active metastatic disease are suspected in the lumbar spine. No vertebral body compression fractures are evident.3.At L3-4, there is a moderate generalized spinal canal stenosis with particular effacement of the right lateral recess due to a disc extrusion. At L4-5, moderate to severe generalized spinal canal stenosis is seen with crowding of the cauda equina nerve roots. The left lateral recess is significantly encroached at this level by a disc extrusion.4.Moderate to severe left foraminal narrowing is seen at L4-5 and L5-S1.