Male, 44 years old, with back pain. Assess L4 pathologic fracture secondary to lung cancer, one month follow-up. A pathologic compression fracture of the L4 vertebral body status post vertebroplasty is redemonstrated. There has been further collapse of vertebral body height with complete loss of height centrally. Retropulsion results in a mild generalized spinal canal narrowing and effacement of the left lateral recess which is similar to the prior examination. Moderate to severe narrowing of the left L3-4 neural foramen is unchanged, while severe narrowing of the left L4-5 neural foramen has progressed.Since the prior examination, a large cystic space containing a blood fluid level within the left posterior paraspinal soft tissues adjacent to L4 has significantly decreased in size. However, a septated or loculated pattern of apparent cystic spaces within the left L4 pedicle and transverse process has become more conspicuous.The epidural tissues and the ligamentum flavum are thickened and enhancing at L3-4, similar to prior. The compressed L4 vertebral body is diffusely enhancing, similar to prior. No definite evidence of any significant epidural tumor is seen.A 1 cm sclerotic focus within the T12 vertebral body is unchanged. A T1 and T2 hypointense, partially sclerotic lesion within the L1 vertebral body seems to have increased slightly in size with a mild increase in surrounding marrow edema. No entirely new osseous lesions are seen.
1.Continued interval collapse of the pathologic L4 compression fracture is seen. Retropulsion at this level continues to result in mild spinal canal narrowing and effacement of the left lateral recess. Severe left foraminal narrowing at L4-5 has progressed.2.Since the prior examination, a large presumed hemorrhagic cavity within the left posterior paraspinal soft tissues at L4 has significantly decreased in size. However, there is a new pattern of apparent cystic spaces within the left L4 pedicle and transverse process. This could represent the development of osseous hemorrhagic cysts related to the fracture or prior instrumentation. The possibility of underlying tumor involvement must also be considered.3.A sclerotic lesion within the T12 vertebral body is unchanged. A partially sclerotic lesion within the L1 vertebral body seems to have increased mildly in size. No entirely new osseous metastases are seen.