Further evaluate cervicothoracic junction for enhancement of the anterior epidural space. Evaluate the lumbar disc as well. Cervical spine:Again seen is patchy marrow replacement involving many of the vertebral bodies of the cervical and visualized thoracic spine concerning for diffuse metastatic disease. However, there is no significant loss of vertebral body height. Again seen at the C5-6 and C6-7 level there is substantial T2 hypointensity matching that of the disc within the ventral epidural space which causes displacement and compression of the spinal cord. There is persistent evidence of a small amount of age-indeterminate cord signal abnormality at the C7 level which is confirmed on the recent previous outside hospital MRI exam of the spine. The T2 signal hypointensity and overall lack of enhancement pattern involving the ventral epidural space at the C5-6 and C6-7 level is compatible with disc extrusion. Infiltration by metastatic disease is thought to be unlikely given the lack of pathologic contrast enhancement in the anterior epidural space. C2-3: Mild left greater than right disc osteophyte complex with a small central disc protrusion is without significant central spinal canal or neural foraminal stenosis.C3-4: Disc osteophyte complex and minimal disc extrusion but no significant central canal stenosis or neural foraminal narrowing.C4-5: Mild facet and uncovertebral hypertrophy left greater than right which causes mild bilateral neural foraminal stenosis. No significant central canal stenosis.C5-6: Moderate facet and uncovertebral hypertrophy as well as a large central disc herniation with extrusion superiorly and inferiorly. As discussed above, this causes moderate to severe central spinal canal and moderate right and mild left neural foraminal stenosis.C6-7: Disc herniation with central disc protrusion which causes moderate bilateral neural foraminal stenosis and moderate central canal stenosis.C7-T1: Mild central disc protrusion but no significant spinal canal or neural foraminal stenosis.Lumbar spine:Patchy marrow replacement involving many of the vertebral bodies of the cervical and visualized thoracic spine concerning for diffuse metastatic disease. The vertebral body heights are preserved. Prominent lordotic curvature of the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.T12-L1 through L3-4: No disc bulge. No significant neural foraminal or central spinal canal stenosis.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal disc bulge but no significant neural foraminal or central spinal canal stenosisL5-S1: Severe disc disease with prominent right greater than left disc herniation at the L5-S1 level causes moderate central spinal canal stenosis. No significant neural foraminal stenosis.
1.Redemonstration of patchy marrow replacement involving much of the cervical and lumbar spine indicating osseous metastases. There is no evidence of abnormal pathologic enhancement within the epidural space to indicate epidural spread of tumor within either the cervical or lumbar spine.2.No pathologic enhancement of the low T2 intensity signal material matching signal of disc in the anterior epidural space at the C5-6 level compatible with disc herniation with superior and inferior extrusion. It is unlikely to represent metastatic epidural spread of tumor given the lack of enhancement and the lack of epidural disease elsewhere in the spine.3.No change in the moderate to severe central spinal canal stenosis at the C5-6 level. 4.Degenerative changes in the lower lumbar spine, most prominent at the L5-S1 level, where there is a prominent central, right greater than left, disc herniation which causes moderate central spinal canal stenosis.