Status post second stage L2 tumor decompression for renal cell carcinoma metastasis. Interval postoperative findings related to debulking of the enhancing epidural component of the L2 vertebral body metastatic lesion and further resection of the left L1-2 facet complex. There is a small amount of residual epidural enhancing tissue on the left, with improvement in the overall degree of spinal canal stenosis and mass effect on the left cauda equina nerve roots at this level, although bone and cement remain retropulsed into the spinal canal. Otherwise, there is a larger amount of residual tumor in the left vertebra and paraspinal space. There are other prior postoperative findings related to resection of the left L2 lamina, pedicle, and part of the transverse process. The operative bed contains a drainage catheter, a small amount of fluid and small amounts of air. There is unchanged compression deformity of the L2 vertebral body with evidence of prior kyphoplasty. There is also unchanged mild compression deformity of the L5 vertebral body with evidence of prior kyphoplasty. In addition, moderate compression deformity of the L1 vertebral body is also unchanged. There is nonspecific enhancement along the superior and anterior aspect of the L3 vertebral body. The bone marrow of the lumbar spine otherwise displays diffusely fatty signal compatible with prior radiotherapy. The distal spinal cord and conus are within normal limits. Aside from the L2 level, there is no significant spinal canal compromise. However, there is mild right or neural foraminal narrowing at L4-5 due to facet hypertrophy. There has been right nephrectomy.
1. Interval aadditional debulking of tumor at the L2 level, small amount of residual epidural enhancing tissue on the left, with improvement in the overall degree of spinal canal stenosis and mass effect on the left cauda equina nerve roots at this level. Otherwise, there is persistent retropulsion of bone and bone cement from prior kyphoplasty at this level. 2. Moderate compression deformity of the L1 vertebral body appears to be unchanged.3. Mild compression deformity of the L5 vertebral body with evidence of kyphoplasty is unchanged. 4. Nonspecific enhancement along the superior and anterior aspect of the L3 vertebral body.5. Diffuse fatty bone marrow related to radiation effects with osteopenia.