Male, 62 years old, with bilateral lower extremity weakness status post partial corpectomy and fusion of T4. Evidence of laminectomy and spinal canal decompression is again seen at T4. Since the prior examination, further surgery has been performed with placement of posterior fusion instruments spanning from T3 through T5. It also appears that further debulking of the tumor expanded T4 pedicles has been performed.With the above interval surgical changes, further decompression of the spinal canal at the T4 level is seen. The spinal cord is no longer compressed and there is now a thin cushion of CSF at least dorsally along the cord which was not previously evident. The cord itself shows no evidence of convincing signal abnormality through the operative field.Elsewhere, the spinal cord is within normal limits and the spinal canal is free of significant encroachment. There remains some postoperative fluid in the posterior soft tissue resection bed at T4, but elsewhere, no concerning paraspinal or epidural collections are detected.As on the prior examination, patchy marrow replacement and pathologic enhancement is again seen with significant involvement of C7, T1, T4 and T9. The T4 and T9 vertebral bodies are mildly compressed, similar to prior. Smaller lesions are also evident at other vertebral body levels similar to prior.Although there is mild vertebral body tumor expansion towards the ventral epidural space at T9, this results in only minimal effacement of the thecal sac. The T9-10 neural foramina are at least moderately narrowed largely due to expansile tumor within the facet complexes.
1.Evidence of interval surgery with further decompression of the spinal canal at the T4 level and placement of posterior fusion instruments spanning from T3 through T5. The spinal canal at the T4 level has been further decompressed and the cord is no longer compressed or impinged.2.Extensive metastatic disease is redemonstrated at multiple additional vertebral body levels. No other significant or high-grade spinal canal stenosis is suspected.