 This exam is limited without gadolinium based contrast. There is transitional anatomy with lumbarization of S1 and 6 lumbar type vertebral bodies. This vertebral body will be termed lumbarized S1 in this report.THORACIC SPINE: There are subtle T1 and T2 hyperintense lesions involving the C7, T5, T7, T8, and T10 vertebral bodies that are most compatible with hemangiomas. The vertebral bone marrow signal is otherwise unremarkable. There is multilevel disc desiccation as well as a small central disc protrusion with mild height loss at T2-T3 without significant spinal canal or neural foramen stenosis. The vertebral body and disc space heights are otherwise preserved. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. LUMBAR SPINE: There is transitional lumbosacral anatomy, with 6 lumbar appearing vertebrae. Assuming the first rib-bearing vertebra is T1, the last fully formed disc is designated as S1-S2 on this exam.There is a compression deformity involving the L1 vertebral body with roughly 70% height loss and associated T1 hypointensity and T2 hyperintensity that extends to involve the anterior pedicles. There is no retropulsion of bony fragments or associated spinal canal stenosis. The vertebral bone marrow signal is otherwise unremarkable. There is minimal grade 1 retrolisthesis of L1 and L2 and of L2 on L3 as well as minimal grade 1 anterolisthesis of L5 on the lumbarized S1. The imaged spinal cord displays normal signal and morphology with the conus terminating at L2. The paravertebral soft tissues are unremarkable. There is bowel in the left renal fossa compatible with history of nephrectomy. There is a 30 x 20 mm T2 hyperintense fluid collection or nodule adjacent to the aorta on the left at the level of L2 that was not definitely present on the prior exams.L1-L2: There is mild disc desiccation without significant spinal canal or neural foramen stenosis.L2-L3: There is mild disc desiccation and disc bulge that is minimally improved as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in moderate right neural foramen stenosis and no significant spinal canal stenosis.L3-L4: There is an unchanged disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. These findings result in unchanged mild spinal canal stenosis as well as mild left and moderate right neural foramen stenosis.L4-L5: There is disc desiccation and a mild disc bulge as well as a small central disc protrusion and severe bilateral facet arthropathy with ligamentum flavum thickening. The disc is unchanged although the facet arthropathy has progressed. These findings result in slightly worsened moderate spinal canal stenosis as well as mild left and moderate right neural foramen stenosis.L5-S1: There is disc desiccation and mild disc height loss as well as a mild disc bulge with a superimposed small central disc protrusion and severe bilateral facet arthropathy, left greater the right. These findings are essentially unchanged and result in moderate spinal canal stenosis and moderate left neural foramen stenosis.S1-S2: There is severe left facet arthropathy without significant spinal canal or neural foramen stenosis.
1.Transitional anatomy with lumbarization of S1. If surgery is to be contemplated, please correlate with imaging of the entire spine.2.Limited exam without contrast.3.Unchanged recent L1 compression fracture without spinal canal stenosis. No additional lesions identified concerning for spinal metastases identified.4.Prominent T2 hyperintense oval structure anterolateral to the aorta at the level of L2 is not well evaluated and may represent a lymph node, post surgical fluid, or a dilated cisterna chyli. This area was only partially imaged on prior CT.5.Minimal thoracic spine degenerative changes.6.Moderate lumbar spine degenerative changes have minimally progressed with at most moderate spinal canal stenosis at L4-L5 and L5-S1 and multilevel severe neural foramen stenosis as well as severe facet arthropathy.