Bilateral lower extremity weakness and T10 sensory level Cervical:Examination is motion degraded limiting evaluation. Again seen are postsurgical changes of anterior corpectomy at C5 with anterior fusion from C4 to C6. Compared to 1/5/2016, there is mild interval worsening of the thecal sac effacement at the C4-C5 level with worsening of epidural enhancement from the C3-C4 to the C5-C6 levels. There is narrowing of the neural foramina at C4-C5 and right worse than left C5-C6 levels related to tumor with osseous destruction, epidural extension, and degenerative disease. Abnormal enhancement at C3-C4 is also again seen. No cord signal abnormality is appreciated. Tumor extension in the right greater than left paraspinous region with encasement of the right vertebral artery again seen. Thoracic:Again seen is severe compression deformity of the T5 vertebral body with diffuse tumor infiltration and retropulsion into the spinal canal with narrowing and compression deformity of the cord, which is worsened since 1/5/2016. Severe vertebral body height loss at T5 is also worsened. There is also mild worsening of the associated kyphosis. There is prominent T1 hyperintensity associated with the tumor as seen before. Epidural tumor involving the ventral epidural space, right worse than left and extending into the right neural foramen is stable to minimally worse. There is complete obliteration of the right T5-T6 neural foramen as before. Moderate pathologic compression fracture at T8 also appears slightly worse, but without associated epidural extension or spinal canal stenosis. There appears to be worsened tumor infiltration at this level including extension into the posterior elements. Abnormal signal involving the T6 vertebral body also appears slightly worse. Aside from T5 and T8, the vertebral body heights are observed. There is increased edema in the thoracic cord at the T5 level.Abnormal signal involving the superior endplate of L3 is partially assessed and nonspecific.There is suggestion of increase in consolidation in the left upper lobe which may be related to worsened tumor but can be better assessed with chest CT.
1. Compared to MRI 1/5/2016, there is worsening of the pathologic compression fracture with retropulsion involving the T5 vertebra which is associated with worsening deformity and compression of the cord as well as increased cord edema.2. Slight worsening of tumor in the cervical spine/epidural space/paraspinous region from the C4 to C6 levels is also suspected. There is moderate spinal canal stenosis at the C4-C5 level which is slightly worse in the interval. No associated cord signal abnormality. Motion degradation and susceptibility artifact related to hardware limit optimal evaluation of the cervical spine.3. Pathologic compression fracture at T8 is also worsened but without epidural extension or spinal canal stenosis. Mild worsening of tumor involving the T6 vertebral body is also noted.4. There is suggestion of increase in consolidation in the left upper lobe which may be related to worsened tumor but can be better assessed with follow-up chest CT.