Diagnosis: Malignant neoplasm of lung. The patient has abnormal gait.Clinical question: With a history of newly diagnosed lung cancer and unsteady gait and a normal MRI brain there is concern that the cause of the abnormal gait is related to spinal metastasis. This patient had prior lumbar spinal injury 12 years ago. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine or within the lumbar spinal canal. The L3 and L4 vertebral bodies are partially fatty replacedAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a disc bulge at this level. There is a left-sided facet hypertrophy and to a lesser degree right-sided facet hypertrophy at this level. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small central disc protrusion present at this level associated with loss of disc space height and some ligamentum flavum hypertrophy. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is obliteration of the disc space at this level and there are associated endplate reactive changes. There is mild facet hypertrophy present at this level. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge and bilateral facet hypertrophy at this level associated with some triangulation of the thecal sac. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is no evidence for metastases to the lumbar spine. 2.There are multilevel degenerative changes present in the lumbar spine as detailed above without significant compromise to the spinal canal or exiting nerve roots.