Back pain. Evaluate for cord compression at L5. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from some loss of lumbar lordosis. The conus medullaris is normal in position.There are multiple T1 hypointense, T2 hyperintense, and enhancing lesions throughout the lumbar spine and visualized pelvis consistent with diffuse osseous metastatic disease. There is diffuse marrow infiltration involving the L5 vertebral body with evidence of pathologic fracture and up to 60% loss of height involving the right aspect of the vertebral body as seen on recent CT from 8/31/2016. There is no significant osseous retropulsion. Marrow infiltration is noted to extend into the posterior elements, right greater than left. There is also abnormal enhancement posterior to the L5 vertebral body likely representing epidural tumor and primarily involving the ventral epidural space from L4-L5 to L5-S1 and extending into the right L5-S1 neural foramen. There is an additional relatively large lesion measuring approximately 2 cm in diameter involving the L4 vertebral body. Relatively large lesions are also involving the left aspect of the sacrum and right iliac bone.Aside from L5, vertebral body heights in the lumbar spine are maintained. Small multilevel Schmorl's nodes are also present involving the superior endplates of the T12 and L2 vertebrae. There are also mild multilevel degenerative changes including small central disc protrusion at the T12-L1 level as well as L4-L5 levels and minimal additional multilevel disc bulges. Degenerative changes also include moderate facet arthropathy at the right L5-S1 level and to a lesser degree left L5-S1 and bilateral L4-L5 levels. There is mild central spinal canal stenosis at the L4-L5 level which is primarily on a degenerative basis. The lumbar spinal canal is otherwise preserved. There is moderate bilateral, right greater than left, L5-S1 neural foraminal stenosis related to combination of L5 pathologic fracture, mild epidural tumor, and degenerative changes. There is also mild left L4-L5 narrowing which is on a degenerative basis.Diffuse osseous metastatic disease is new compared to lumbar spine MRI from 1/22/2010. Compared to more recent PET from 3/14/2016 there also appears to be progression of metastatic disease. The pathologic fracture at L5 also appears new since then although present on recent CT from 8/31/2016.
1. Diffuse osseous metastatic disease involving the lumbar spine and pelvis including diffuse tumor infiltration of the L5 vertebral body extending into the posterior elements, epidural tumor from L4-L5 to L5-S1, and pathologic fracture at L5. Additional details as above.2. Mild central spinal canal stenosis at the L4-L5 level which is primarily on a degenerative basis. The lumbar spinal canal is otherwise preserved. There is moderate bilateral, right worse than left, L5-S1 neural foraminal stenosis related to combination of L5 pathologic fracture, epidural tumor, and degenerative changes.