Secondary malignant neoplasm of bone and bone marrow(198.5)Closed fracture of lumbar vertebra without mention of spinal cord injury There is a marrow replacing lesion present within the L1 vertebral body with epidural soft tissue and extension into the right pedicle and adjacent neural foramina. This is clearly progressed compared to the prior exam in January where it didn't extend the spinal canal or the neural foramina. Since the March exam that progression is more subtle but still present. There is since March there is greater compression of the right half of the L1 vertebral body. The conus medullaris is not compressed. There is crowding of the right-sided nerve roots of the cauda equina by the tumor extension into the right hemicanal. The exiting nerve roots within the neural foramina are surrounded by fat.At L5-S1 there is no significant compromise to spinal canal. There is a disc bulge present at this level. The fat surrounding the exiting nerve roots within the neural foramina is partly effaced - right worse than left.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge at this level. There is some vacuum disc phenomenon present at this level. The fat at the lateral recess is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is partly effaced and the neural foramina are narrowedAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is absent.
1.An L1 vertebral body lesion has progressed since previous CT exams. It extends into the spinal canal and impresses on the thecal sac and also mildly encroaches on the adjacent neural foramina at T12-L1 and L1-L2. The compression fracture at this level has progressed.2.There are degenerative changes present in the lumbar spine with mild encroachment of the exiting nerve roots on the right side at L5-S1.