Male, 65 years old, with a right leg pain, shooting down the leg, back pain, reported weakness, history of prostate cancer. Diffuse patchy marrow replacement is seen compatible with widespread osseous metastatic disease, progressed from the prior MRI. No compression deformity is noted. The most conspicuous tumor deposit involves L5 and the sacrum, which show near complete marrow space involvement. At L4-5, spondylolisthesis, bulging disc and facet hypertrophy contribute to produce a moderate to severe spinal canal stenosis and bilateral foraminal narrowing. There was stenosis at this level on the prior examination, but it has progressed in the interval. Given the extensive tumor involvement of the sacrum, the possibility of foraminal encroachment and nerve root impingement by tumor is raised. Elsewhere, no significant spinal canal or foraminal stenosis is seen.
1.No evidence of acute cord compression is seen.2.Widespread osseous metastatic disease is seen.3.A large tumor deposit involving L5 sacrum seen which may contribute to L5-S1 and sacral foraminal encroachment and possible nerve root impingement. If clinically warranted, these findings can be better assessed with nonemergent dedicated lumbosacral imaging.4.Degenerative disease at L4-5 results in a moderate to severe spinal canal stenosis and foraminal narrowing, progressed from the prior examination.