Female, 57 years old, with history of T-cell lymphoma and spinal metastases, status post extensive thoracic and lumbar spinal surgery, with chronic right lower extremity weakness. Dependent on walker/wheelchair, but able to ambulate at baseline. Now with worsened right lower extremity weakness and inability to ambulate. Cervical:There may be a mild curvature of the cervical spine in the coronal plane, but this could be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is observed.Minimal disc degeneration is seen without significant compromise of the spinal canal or neural foramina.Thoracic:Evidence of instrumented posterior fusion is again seen beginning at T4 and continuing down to T11. The T8 vertebral body shows complete loss of height with artifact related to a spacer device within the right aspect of the vertebral body. These findings are unchanged from prior.The T10 vertebral body remains partially compressed with heterogeneous marrow signal, similar to prior. The remaining vertebral bodies demonstrate relatively unremarkable or only mildly heterogeneous marrow signal characteristics. No pathologic enhancement is suspected.A mild focal kyphosis is evident at the T3-4 level. A focal kyphosis is also evident at the T8 level. Anterior subluxation of T7 relative to T9 is unchanged.The spinal canal remains mildly narrowed at the T8 level due to vertebral body subluxation and and the compression deformity, but there is evidence of posterior decompression and the overall appearance is unchanged. Artifact from orthopedic instrumentation prevents accurate assessment for subtle cord signal abnormality, but no significant interval changes are suspected.No significant disc bulging or disc herniation is seen. The spinal canal is otherwise patent. The T8-9 neural foramina are not well visualized but are presumably significantly narrowed.Opacification possibly representing atelectasis is seen in the lung bases.Lumbar:Based on vertebral body counting from above, and the location of the last set of ribs, there are four lumbar type vertebral bodies.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.The intervertebral disc spaces are preserved with no significant disc bulge or disc herniation identified. Facet hypertrophy develops at lower lumbar levels. The spinal canal and neural foramina remain patent.
1.Demonstration of findings related to extensive posterior instrumented fusion in the thoracic spine with a complete compression of the T8 vertebral body. The spinal canal may be mildly narrowed at this level, but has been decompressed posteriorly and the appearance is unchanged.2.Mild compression of the T10 vertebral body along with heterogeneous marrow signal characteristics suggesting treated disease are unchanged. No new compression deformity or pathologic marrow process is suspected.3.Relatively unremarkable evaluations of the cervical and lumbar spine with no new or significant findings to account for the patient's worsening symptoms.