Male, 67 years old, with right-sided back pain radiating down leg, positive straight leg test, history of herniated disc status post discectomy now with recurring pain on the right side. Innumerable foci of marrow replacement are identified involving every level of the spine as well as the visualized sacrum and iliac bones. At several levels, significant tumor extension is seen into the epidural and/or extraosseous spaces with details as follows:At T2, extraosseous or epidural tumor extension causes effacement of the left aspect of the spinal canal, completely excluding CSF, deforming and displacing the cord to the right. Tumor extends into the left T1-2 and T2-3 neural foramina.At T5, extraosseous or epidural tumor extension is seen on the left causing effacement of the left spinal canal, with deformity and rightward displacement of the spinal cord. The left C5-6 neural foramen is invaded.At T6, ventral epidural tumor extension is seen bilaterally with narrowing of the spinal canal and bilateral deformity of the spinal cord. The left T6-7 neural foramen is invaded as well.At L3, tumor within the right lateral and posterior epidural space causes significant effacement of the spinal canal, exclusion of CSF, deformity and displacement of the cauda equina towards the left. A smaller quantity of epidural tumor is also seen on the right at L1 and L2. The right L1-2, L2-3 and L3-4 neural foramina are all invaded by tumor.Numerous additional areas of epidural invasion are seen throughout the spine, though with less severe compromise of the spinal canal and neural foramina. At no point is there any definite evidence of spinal cord edema. No pathologic spinal cord or leptomeningeal enhancement is identified.Spinal alignment is grossly anatomic. Vertebral body heights are preserved. In the cervical spine, disc osteophyte formation is seen from C4-5 through C7-T1 but without significant spinal canal compromise. The neural foramina at these levels are mildly to moderately narrowed. In the lumbar spine, disc bulging and osteophytic ridging is seen at L4-5 and L5-S1, again without significant spinal canal compromise. Moderate bilateral foraminal narrowing seen at L5-S1.
Diffuse osseous metastatic disease is seen involving every level of the spine and the visualized sacrum and iliac bones. At multiple levels, epidural tumor extension is seen causing severe spinal canal compromise and impingement or displacement of the spinal cord or cauda equina with details as above. At no level is there any definite evidence of cord edema.After initial attempts to contact by page, these findings were communicated to Drs. Campbell and Meza by email at 8:15 PM on 11/11/16. 