Male, 50 years old, history of metastatic renal cell cancer status post neurosurgical decompression and hardware. Thoracic:Since the prior examination, the patient has undergone instrumented posterior spinal fusion. Pedicle screws are in place bilaterally at T7, T8, T11 and T12, affixed to posterior stabilization rods. Fixation continues into the lumbar spine as discussed in the next section.Laminectomy has been performed at least partially at T8 and completely at T9 and T10. This results in spinal canal compression.Near complete marrow replacement and pathologic enhancement is again seen at the T9 vertebral body and pedicles with evidence of osseous expansion. The extent of this abnormality has slightly progressed from the prior examination. Also progressed is the degree of osseous retropulsion and/or epidural disease spread into the ventral epidural space. There is progressive near complete effacement of CSF at this level, and the bilateral T9-10 neural foramina are encroached upon by tumor. Progressive marrow replacement and pathologic enhancement is seen at the T10 vertebral body level. There is no significant retropulsion or epidural disease spread detected at this level.A bulky tumor deposit at the left T3 costovertebral junction has increased slightly in size as well.Lumbar:The inferior extent of the instrumented spinal fusion is seen. Spinal fusion continues with bilateral pedicle screws at L2 and L3. Corpectomy with strut graft placement has also been performed at the L1 level. Laminectomy has been performed at least partially at T12 and at L1 for spinal canal decompression.The remaining L1 vertebral body continues to show diffusely abnormal signal characteristics. Elsewhere in the lumbar spine, no definite evidence of new or progressive marrow signal abnormality is seen. The right aspect of the sacrum, however, does show evidence of progressive marrow replacement. A small focus of marrow replacement is also seen in the left iliac bone.The cervical lordosis is straightened. Sagittal alignment is otherwise unremarkable.L1-2: Posterior canal decompression. No significant left foraminal narrowing, the right neural foramen appears to be encroached upon by residual tumor in the L1 vertebral body. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild generalized spinal canal narrowing. No significant foraminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. Very mild bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and minimal disc bulging. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. The right sided sacral foramina are encroached upon by the above-mentioned tumor deposit.
1.Interval postoperative findings including instrumented posterior spinal fusion from T7 through L3.2.Laminectomy for posterior spinal canal decompression has also been performed from T8 through T10 and from T12 to L1.3.Corpectomy with strut graft placement has been performed at L1.4.Tumor within the T9 vertebral body has progressed appearing bulkier and with a greater degree of epidural encroachment. The spinal canal has, however, been decompressed posteriorly at this level.5.Progression of tumor is also seen within T10 and at the left T3 costovertebral junction.6.Apart from the residual L1 vertebral body which still contains tumor, no definite metastatic disease is detected elsewhere in the lumbar spine.7.Progression of tumor is seen in the right aspect of the sacrum with encroachment upon the sacral neural foramina. A small focus of tumor is also seen within the left iliac bone.