Low back pain. Patient with carcinosarcoma of the ovary status post secondary debulking with large retroperitoneal adenopathy extending from bifurcation to renal arteries, rule out invasion of spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L1 on L2 and L2 on L3. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No abnormal enhancement within the spinal canal or neural foramina. No evidence of epidural or leptomeningeal tumor.Multilevel degenerative changes are seen with disc desiccation and height loss at multiple levels, including in the partially imaged lower thoracic spine. Individual levels in the lumbar spine as below:L1-L2: Mild disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with small central extrusion with suspected subligamentous inferior extension along the posterior aspect of the L3 vertebral body (sag T2 image 9). There is however no significant associated spinal canal or neural foraminal stenosis. L3-L4: Small central disc protrusion. No significant spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. There is moderate bilateral facet arthropathy.L5-S1: Disc desiccation with mild height loss; otherwise no significant disc disease. No spinal canal or neural foraminal stenosis. There is advanced bilateral facet arthropathy with partial ankylosis.Small disc calcifications and small posterior endplate osteophytes are better appreciated on prior CT. Retroperitoneal lymphadenopathy in the left periaortic region is noted and better assessed on prior CT study. Degenerative changes involving the bilateral sacroiliac joints are also noted.
1. There is left retroperitoneal para-aortic lymphadenopathy which is better assessed on prior CT study. There is no evidence of invasion into the lumbar spine.2. Multilevel degenerative changes in the lumbar spine as detailed above without significant spinal canal or neural foraminal stenosis at any level. There is a small disc extrusion which is suspected to originate from L2-L3 and extends inferiorly along the dorsal aspect of the L3 vertebral body. There is also facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.