Patient with history of prostate cancer, status post spinal decompression, evaluate thoracic and lumbar spine. Patient status post T3-T5 and T11-L1 laminectomies on 6/24/2016. Thoracic spine:Redemonstrated are numerous foci of signal abnormality within the visualized osseous structures compatible with widespread osseous metastatic disease. There is slightly exaggerated thoracic kyphosis. Postsurgical changes the T3-T5 laminectomy are noted. At the level of the decompressive laminectomy at T4, there is increased CSF dorsally in the thecal sac as compared to prior exam, however there is residual effacement of the spinal canal laterally with persistent deformity of the cord. The epidural tumor at this level is better appreciated on prior postcontrast sequences from 6/23/2016. There is pathological compression fracture of the T4 vertebral body, progressed compared to the prior exam (approximately 30 percent loss of height on current study, minimal height loss previously). Thoracic cord signal abnormality at this level is again seen slightly more prominent/apparent.Postsurgical changes of T11-L1 laminectomies are present with spinal cord appearing well decompressed at this level. Residual epidural tumor at this level is noted without significant mass effect on the cord. No new level of significant thoracic spinal canal stenosis. Aside from the T4 level, vertebral body heights are grossly maintained. Small epidural as well as posterior paraspinous fluid collections are seen at the level of the decompressive laminectomy.Expansile lesion involving the right posterior chest wall is again seen.Lumbar spine:There are numerous foci of signal abnormality within the visualized osseous structures in the lumbar spine compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. Multilevel degenerative changes including disc bulges, mild to moderate multilevel neural foraminal stenoses, and facet arthropathy. Conus medullaris terminates at the level of the L1-L2.
1.Widespread osseous metastatic disease again seen. 2.Patient is status post T3-T5 laminectomies for surgical decompression, where there is relatively improved but persistent deformity of the spinal cord at the T4 level. Cord signal abnormality at this level appears slightly more prominent/more apparent than prior.3.Patient is status post T11-L1 laminectomies for surgical decompression, where the spinal canal is well decompressed.4.Pathologic compression fracture of T4 has progressed compared to the prior exam of 6/23/2016.