47 year old male with metastatic squamous cell carcinoma in October 2014 (to brain, lung, liver and bones) s/p 6 cycles of Cisplatin/Docetaxel, resection of right temporal brain metastasis on 5/20/15, and adjuvant SRS on 6/9/15. Back pain. The study is limited by patient motion. Five lumbar type vertebral bodies are presumed to be present. Lumbar spine alignment is near anatomic. There is diffuse low T1 signal involving the L3 vertebral body with involvement of the left pedicle, and diffuse enhancement consistent with metastasis. Posterior elements are otherwise intact. There is a Schmorl's node along the superior endplate of L3 vertebral body, without significant overall loss of vertebral body height at L3 or elsewhere in the lumbar spine.There is a subcentimeter T1 hypointensity, with questionable enhancement along the anterior aspect of S1 vertebral body, which is nonspecific but may represent additional metastasis. There is a 13 mm T1 hypointensity in the left iliac bone with minimal enhancement also concerning for metastasis.No evidence of epidural tumor or leptomeningeal enhancement. There is evidence of multilevel disc desiccation. The disc space heights are maintained. The distal spinal cord and the conus medullaris is normal in position and shows normal signal intensity.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc protrusion with mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is minimal disc bulge with small annular fissure, resulting in mild right neural foraminal narrowing. No left neural foraminal narrowing. There is mild spinal canal stenosis.L4-L5: There is disc bulge with indentation of the anterior thecal sac. There is mild facet arthropathy, ligamentum flavum thickening and epidural lipomatosis also contribution to mild to moderate spinal canal stenosis. No significant neural foraminal stenosis. L5-S1: There is minimal disc bulge. No significant spinal canal or neural foraminal stenosis. There is mild facet arthropathy and ligament flavum thickening.Paraspinous soft tissues are within normal limits.
1. Metastatic lesion involving L3 vertebral body extending into the left pedicle. Additional 13 mm lesion involving left iliac bone and a subcentimeter focus along the S1 vertebral body are more nonspecific, but may represent additional metastases. Bone scan may be considered to assess the overall burden of metastases if clinically indicated. No evidence of epidural tumor, pathologic compression fractures, or leptomeningeal disease.2. Multilevel degenerative changes as described above with mild-to-moderate spinal canal stenosis at L4-5. 