Malignant neoplasm of endometrium [C54.1] / Lumbago with sciatica, right side [M54.41] / Lumbago with sciatica, left side [M54.42], Reason for Study: ^Reason: Hx: recurrent endometrial cancer with worsening back pain. Please eval for cord compression. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is acute compression fracture of L4 vertebral body with about 30% height reduction associated with bone marrow edema. On Gad enhanced scan, there is diffuse relatively homogenous enhancement of the L4 vertebral body which is matching with bone marrow edema extent. There is also relatively smooth enhancement surrounding the L4 vertebral body.There is no evidence of spinal canal stenosis or cord compression.There is grade 1 anterolisthesis of L5 on S1, but no evidence of spinal canal stenosis, nor neural foraminal stenosis.There is normal lumbar lordosis. The spine alignment is anatomic. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level.
1. About 30% of compression fracture with bone marrow edema at the level of L4 vertebral body with enhancement. Most likely diagnosis would be osteoporotic compression fracture, however, considering the patient's history of endometrial cancer, metastatic compression fracture cannot be completely excluded.2. Grade 1 anterolisthesis of L5 on S1 without evidence of spinal stenosis.Comment: Neurointerventional evaluation and possible kyphoplasty with bone biopsy is recommended. I have discussed with Dr.Fleming and we both agreed on above plan.