77 yo male with metastatic prostate cancer, low back pain, right lower extremity pain and weakness For the purposes of numbering, there are 5 lumbar type vertebral bodies. Again seen are postsurgical changes of posterior instrumentation at the L4-L5 level with paraspinous rods and pedicle screws better assessed on recent CT. There is extensive marrow infiltrating tumor involving the L4 and L5 vertebrae. No recent MRI is available, however there is clear progression of tumor when compared to prior MRI dated 7/17/2012 with increased marrow infiltration involving the L4 and L5 vertebral bodies extending into the posterior elements and epidural space. There also multiple additional small enhancing lesions including the T10 vertebral body as well as the sacrum which are new since prior study from 2012.There is minimal loss of height involving the L4 and L5 vertebral bodies; vertebral body heights are otherwise grossly preserved. Alignment is within normal limits. There is moderate stenosis involving the spinal canal at the upper L4 level which becomes severe at the mid L5 level related to combination of epidural tumor tumor, posterior convexity of the L5 vertebral body and degenerative changes. Thecal sac becomes patent more inferiorly at the L5-S1 disc level. There is a prior laminectomy at the L4-L5 level; however the CSF spaces at this level remain effaced.There is moderate to severe stenosis involving the right L4-L5 neural foramen and moderate stenosis involving the right L5-S1 neural foramen. There is mild left L4-L5 and mild to moderate left L5-S1 neural foraminal narrowing. Expansile bone remodeling related to infiltrating tumor is better appreciated on recent CT. There is no significant spinal canal or neural foraminal stenosis at the L1-L2, L2-L3, and L3-L4 levels. Epidural enhancement dorsal to the L3 vertebral body is nonspecific and not definitively indicative of tumor. Small fluid collection in the posterior paraspinous soft tissues at the L5 level is noted but smaller than 2012.
1. No recent MRI is available for comparison however compared to 7/17/2012, there is evidence of progressive infiltration of the L4 and L5 vertebral bodies extending into the posterior elements as well as increased epidural tissue. There is moderate spinal canal stenosis at the upper L4 level. Spinal canal stenosis becomes worse more inferiorly and is severe at the mid L5 level. Thecal sac becomes patent again further inferiorly at the L5-S1 disc level.2. There is also worsening neural foraminal stenosis related to epidural tumor and expansile bony remodeling related to the infiltrating tumor, particularly on the right, where there may be impingement of the exiting right L4 and L5 nerve roots.3. Please see additional details above, including multiple new foci of osseous metastatic disease.