Female, 57 years old, status post L2 tumor decompression. Interval postoperative findings are seen compatible with resection of the left L2 lamina, pedicle, and part of the transverse process. The operative bed contains fluid and a bubble of air. Also resected was a portion of the previously demonstrated progressive tumor at L2. There remains enhancing tumor along the left lateral margin of the vertebral body which is at least partially extraosseous, and a small nodule of residual tumor medial to the resection bed. This nodule continues to indent the thecal sac exerting mass effect upon the adjacent cauda equina nerve roots.A severe compression deformity of the L2 vertebral body is redemonstrated with evidence of prior kyphoplasty. A mild compression deformity of the L5 vertebral body is unchanged, also with evidence of prior kyphoplasty. A moderate compression deformity of the L1 vertebral body is unchanged.No new focal marrow space or epidural lesions are identified. The marrow signal characteristics of the lumbar spine are diffusely fatty compatible with prior radiotherapy. The visualized distal spinal cord and conus are within normal limits. As above, there is crowding of the cauda equina at the L2 level, but below this the spinal canal is not significantly compromised.At L1-2, the spinal canal is mildly compromised due to disc degeneration and vertebral body retropulsion. The left neural foramen is mildly narrowed as well.At L2-3, and particularly at the level of the L2 vertebral body, bony retropulsion and the presence of residual tumor contribute to a moderate to severe narrowing of the thecal sac with crowding of the cauda equina. The left neural foramen has been surgically decompressed. The right neural foramen is mildly narrowed.At the remaining levels, mild facet arthropathy is seen without significant spinal canal or foraminal compromise.
1.Postoperative findings are seen compatible with resection of the left L2 lamina, pedicle and part of the transverse process. The previously demonstrated progressive tumor at this level has also been debulked.2.There remains residual L2 tumor along the left lateral aspect of the vertebral body, and along the medial aspect of the resection bed. This medial tumor component continues to indent and narrow the thecal sac. The left L2-3 neural foramen has been surgically decompressed.3.Multiple compression deformities and evidence of prior kyphoplasty are redemonstrated without significant interval change. No new osseous lesions are suspected.