Prostate cancer with tremor and weakness. Thoracic spinal metastasis. Status post decompression and fixation. Since the prior examination, there has been T6 through T8 laminectomies along with posterior fixation with dual posterior rods and bilateral screws at T4, T5, T9 and T10 levels. At the laminectomy bed, there is heterogeneous material, which may reflect fluid mixed with blood products. Also, there has been partial resection of the epidural component of the osseous metastatic tumor, which involves mainly T7 and partially posteriorT6 and T8 vertebral bodies and pedicles. While epidural tumor tissue remains especially at T7 level. Compared to the preoperative examination, there is less retropulsion at T7 level with resolution of the mass-effect on the spinal cord and slightly wider anterior CSF space. However, the posterior CSF space at this level is slightly smaller than preoperatively, which may relate to the mass-effect caused by the fluid at the laminectomy bed. Overall, the most prominent residual epidural component involves the right anterolateral aspect of the spinal canal at the lower T7/upper T8 level. Contrast enhancement in the osseous part of the tumor is decreased compared to the preoperative examination but this likely reflects technical variation. There continues to be significant involvement of the neural foramina by the metastasis, especially on the right, at T7-T8 and to lesser extent T6-T7 and T8-T9. The other thoracic neural foramina are preserved.Also, there is no direct compression of the spinal cord at this level or the other levels. However, there is artifact, especially at the levels of the screws, mildly limiting the examination for cord compression.Acute postoperative changes are present in the surgical bed and the overlying back soft tissues.There is multilevel cervical spondylosis which is not completely assessed. This is associated with anterior subluxation of C7 relative to T1 resulting mild spinal canal but more significant neural foraminal stenosis.
1.Since the previous examination, there has been posterior T6-T8 decompression and T4-T10 posterior fixation, as described above. In addition, there has been partial debulking of the epidural component of the osseous metastasis involving mainly T7 and to a lesser extent T6 and T8 vertebral bodies and pedicles. The posterior retropulsion at T7 has improved with out definite residual direct mass-effect on the spinal cord.2.There remains near complete effacement of CSF space at the T7 level, as there is a mixed signal intensity postoperative epidural collection along the laminectomy bed.3.The residual epidural component is most pronounced right anterolaterally at T7-T8 level.4.Persistent significant involvement of the neural foramina by the metastasis, especially on the right as described above