Female, 69 years old, status post tumor resection. Evidence of laminectomy is seen at least at T5 and possibly at T4 and T6 as well though these areas are obscured by metal artifact. Instrumented posterior spinal fusion has been performed with bilateral pedicle screws in the T4 and T6 vertebral bodies affixed to posterior stabilization rods.A previously seen bulky tumor involving the left T5 pedicle, transverse process, a small part of the vertebral body and the adjacent rib head appears to have been at least partially resected. The transverse process and part of the vertebral body are absent. Part of the adjacent left rib head may also have been resected. The tumor bed does remain filled with soft tissue material of uncertain composition, possibly representing a combination of residual tumor and surgical packing material. Of note, it does appear that epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination has been relieved.There appears to be a fracture of the proximal left T4 rib, with T1 hypointensity in the adjacent marrow possibly reflecting edema or marrow replacement. This finding was present on the prior examination.Evaluation of the spinal cord is limited in the region of the pedicle screws, but elsewhere the cord shows normal signal intensity and morphology. No areas of significant spinal canal stenosis or cord impingement are suspected.Vertebral bodies are normally aligned with a slightly exaggerated thoracic kyphosis. Vertebral body heights are preserved.
Findings are seen compatible with at least partial resection of a tumor deposit involving the T5 pedicle, transverse process and rib head. Posterior instrumented spinal fusion has also been performed from T4 through T6.Soft tissue material in the tumor bed is of uncertain etiology and could represent a combination of both residual tumor and surgical packing. Epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination have been relieved.A fracture through the proximal left T4 rib is suspected, unchanged from the prior examination. It is unclear if this is a benign fracture or a fracture through a metastatic deposit.