Male, 79 years old, with right lower extremity weakness, history of prostate cancer and renal cell carcinoma. Evaluate for metastatic disease. Since the prior examination, the compression deformity of L3 has progressed with at least 60% loss of vertebral body height. The marrow space is more diffusely STIR hyperintense and enhancing.A chronic compression deformity of the L1 vertebral body is unchanged. The remaining vertebral bodies demonstrate preservation of height.Mildly diminished T1 and T2 signal intensity is seen in T11, T12, L2 and L4, of uncertain significance but unchanged from prior examination. These vertebral bodies demonstrate no abnormal STIR signal or pathologic enhancement. A subcentimeter focus of T2 hyperintensity and enhancement within the left anterior L2 vertebral body is unchanged and nonspecific.There is mild retropulsion of the L1 vertebral body due to compression. Otherwise, sagittal alignment of the spine is grossly anatomic.T12-L1: Mild retropulsion of the L1 vertebral body but no significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L1-2: Ligamentum flavum thickening, and mild bilateral facet joint arthropathy. Minimal disc bulging. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. No interval changes. L2-3: Minimal disc bulge. Ligamentum flavum thickening, and moderate bilateral facet joint arthropathy. There is a left far lateral annular disc fissure. There is bilateral mild neural foraminal narrowing. There is mild narrowing of the spinal canal with effacement of the CSF space anteriorly. No interval changes.L3-4: Ligamentum flavum thickening. Moderate to severe bilateral facet joint arthropathy. Trace bulging disc. Moderate generalized spinal canal narrowing with crowding of the cauda equina. There is moderate right and mild left neural foraminal narrowing. No interval changes.L4-5: Ligamentum flavum thickening. Moderate to severe bilateral facet joint arthropathy . Mild disc bulging with only mild spinal canal narrowing. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.
1.Progressive compression of the L3 vertebral body is seen. The marrow space is now more uniformly edematous and enhancing. The possibility of an underlying metastatic lesion cannot be excluded though the signal characteristics of the marrow could entirely reflect fracture-related edema and inflammation.2.No other definite metastatic lesions are seen in the lumbar spine. A chronic compression deformity of the L1 vertebral body is unchanged.3.Multilevel disc degeneration is also unchanged.