Female, 57 years old, with metastatic renal cell carcinoma to L2 status post prior RT, kyphoplasty and recent debulking. Evaluate for extent of disease now five weeks postop. Postoperative findings are redemonstrated at L2 including resection of the left lamina, pedicle, transverse process and facet complex. Fluid and edema within the epidural operative bed are similar to the prior examination. A new fluid collection is also noted within the superficial soft tissues of the operative bed measuring up to 4 cm in diameter. The caliber of the thecal sac at L2 is similar to the immediate prior examination and improved relative to the older preoperative examination. The left L1-2 neural foramen remains narrowed. The left L2-3 neural foramen is surgically decompressed. Extraosseous tumor involving the left lateral extraosseous tissues at L2 is similar to the prior examination.Again seen is evidence of kyphoplasty at L2 and L5 with findings appearing similar to prior. A moderate compression deformity of the L1 vertebral body is also unchanged. Diffuse fatty marrow infiltration of the lumbar spine is compatible with prior radiotherapy. Abnormal STIR signal and enhancement involving the right L4 pedicle and inferior articulating facet have become more conspicuous. No other areas of new or progressive signal abnormality are seen. Degenerative findings are unchanged. No significant compromise of the spinal canal is seen at any level.
Evolving postoperative findings are seen compatible with tumor debulking at L2. The caliber of the thecal sac at L2 is similar to the immediate prior examination and improved relative to preoperative studies. A fluid collection within the superficial operative bed is new.Abnormal signal and enhancement involving the right L4 pedicle and inferior articulating facet are concerning for metastatic involvement. These findings have become more conspicuous when compared to prior examinations. No additional new lesions are seen.