Fifty year-old male with history of L4 plasmacytoma status post resection and radiation. Worsening left foot drop. Exam is limited by artifact related to orthopedic hardware, which includes wire cage device placement at L4 as well as posterior stabilization rods and transpedicular screws at L3 and L5. Sagittal T1 fat saturated images are also limited due to hardware artifact. Axial images, however, demonstrate new T1 and T2 hyperintense signal involving the L3, L4, and L5 vertebral bodies diffusely; likely representing radiation-related changes. Within the L4 vertebral body, there are also irregular, lobulated areas of T1 hypointensity which extend through the pedicles bilaterally, and which enhance on postcontrast images; these signal characteristics are similar to that seen of the entire L4 vertebral body on the previous exam.The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is minimal disk bulge and posterior element hypertrophy without significant compromise to spinal canal or neural foramina.At L3-4 in addition to postoperative changes, there is a mild diffuse disk bulge with left-sided prominence. There is no significant central canal stenosis and or neuroforaminal compromise. At L4-5 in addition to postoperative changes, there is mild disk bulge with left-sided prominence as well as posterior element hypertrophy. There is no significant central canal stenosis but moderate left neuroforaminal stenosis.At L5-S1 there is mild disk bulge and moderate bilateral facet hypertrophy, with mild right and mild to moderate left neuroforaminal stenosis, slightly progressed from the previous exam. No significant central canal stenosis.
1.Slightly progressed mild to moderate L5-S1 left neuroforaminal stenosis. Redemonstrated moderate left L4-5 neuroforaminal stenosis.2.New radiation-related marrow changes in the L3, L4, and L5 vertebral bodies. Upon this background, there are nonspecific, stable areas of enhancement in the L4 vertebral body; given complete stability, would favor this to represent granulation tissue and/or other post-treatment changes.3.Orthopedic hardware, as above.