Metastatic lung adenocarcinoma. History of spine metastasis. Evaluate for change and for preoperative planning. Since the previous examination, the posterior fusion hardware has been extended to T3-T7 with bilateral screws at T3, T4, T6 and T7 levels as well as posterior dual rods in addition to T4-T6 laminectomies. Partial corpectomy and and right transversectomy were performed at T5, in addition to previous left costotransversectomy. There is bone cement in the deep/anterior partial corpectomy bed, but also extending outside the corpectomy bed on the left side. There is intensely contrast enhancing tissue filling the remainder of the partial corpectomy bed and costotransversectomy, which is predominantly right sided though a thin rim of the same tissue does wrap around the thecal sac on the left side. This would be most compatible with recurrent tumor and it mildly deforms the spinal canal and thecal sac though with residual CSF around the spinal cord and no spinal cord compression. In the axial plane, this contrast enhancing tissue measures 4.1 cm x 3.2 cm. Craniocaudally, it measures 4.4 cm. It reaches to the right costochondral junction but without definite rib involvement. Most of the left costotransversectomy bed is filled with postoperative change.There is slightly increased thoracic kyphosis across the fused segment compared to the previous examination but this may relate also to patient position. The Cobb angle measured from the superior endplate of T1 to the inferior endplate of T12 is now 72 degrees compared to 66 degrees previously.Accounting for metallic artifact related to the screws and the posterior rods, there is no compression of the spinal cord at the other levels. This artifact also does not allow for accurate assessment of the marrow comment T3-T7 levels. There is also no suspicious marrow abnormality at other levels to indicate the presence of other thoracic spine metastasis.Postoperative changes are present in the back posterior soft tissues at midline. Dependent pulmonary opacities may represent atelectasis and scarring but this study does not allow for diagnostic long assessment.
1.Compared to the previous examination of June 2015, the posterior fusion has been extended, now T3-T7. Also partial corpectomy and right transversectomy were performed at T5, in addition to previous left costotransversectomy.2.Contrast enhancing tissue that is predominantly left-sided at the T5 corpectomy/costotransversectomy bed is most compatible with recurrent tumor. It mildly compresses the spinal canal but causes no spinal cord compression.3.Other ancillary and postoperative findings are described above.