64-year-old with right upper lobe adenocarcinoma presenting with acute lumbar pain since one week. Evaluate for metastasis, radiculopathy, or other acute changes. Five lumbar type vertebral bodies are present. There is loss of normal lumbar lordosis with mild convex leftward curvature of the lumbar spine centered at the L2-L3 level. Conus is in normal position at the upper L2 level.Multilevel degenerative changes are seen with significant loss of disc space at the L2-L3, L3-L4, L4-L5, and L5-S1 levels with prominent areas of subchondral sclerosis and cyst formation as well as vacuum disc phenomena better appreciated on recent abdominal CT. Bone marrow signal is heterogeneous. There is abnormal enhancement involving the L4 and L5 vertebral bodies which is favored to be on a degenerative basis. There is somewhat more suspicious enhancement involving the L1 vertebral body with a rounded area of enhancement measuring approximately 16 mm x 14 mm in the AP and craniocaudal dimensions. No evidence of compression fractures or epidural tumor.Individual levels as below:L1-L2: Minimal disc bulge and prominence of the epidural fat. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge eccentric to the right and prominence of the epidural fat. No spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.L3-L4: There is disc bulge and prominence of the epidural fat with mild spinal canal stenosis. There is moderate right and minimal left neural foraminal stenosis.L4-L5: Disc bulge, prominence of the epidural fat, ligamentum flavum thickening, and facet arthropathy result in moderate spinal canal stenosis. There is moderate right-sided neural foraminal stenosis and severe left neural foraminal stenosis.L5-S1: Mild disc bulge and prominence of the epidural fat. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.
1. Multilevel degenerative changes throughout the lumbar spine. Bone marrow signal is heterogeneous with edema and enhancement involving the L4 and L5 vertebral bodies which is likely on a degenerative basis. There is a more rounded focus of enhancement involving the L1 vertebral body which is slightly suspicious and measures approximately 16 x 14 mm. Consider short-term follow-up MRI to assess for stability or bone scan for further evaluation. There is otherwise no definite evidence of metastatic osseous disease. No evidence of pathologic compression fractures or epidural tumor.2. Degenerative changes resulting in up to moderate spinal canal stenosis at the L4-L5 level. There is also moderate right and severe left neural foraminal stenosis at L4-L5. Additional levels as detailed above.