Reason: Patient with PMHx of RCC, prostate CA, presenting with RLE weakness, concern for cord compresison as etiology History: Acute LRE weakness, 1 wk hx of back pain There is moderate loss of height of the L1 and L3 vertebral bodies. The L3 vertebral body demonstrates increased STIR signal intensity, suggesting a more recent compression, while at the L1 level it appears chronic. There is mild vertebral body retropulsion at the L1 and L3 levels, without significant spinal canal stenosis. There is uniformly decreased T1 and T2 signal intensity without enhancement or STIR abnormality affecting the T12 and L2 vertebral bodies. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. An enhancing subcentimeter round focus with high T1 signal intensity within the mid anterior L2 vertebral body is compatible with an atypical hemangioma, and was seen on the CT scan dated 1/22/2016. There is mild multilevel degenerative disc disease. At L1-L2, there is minimal bilateral disc bulge, ligamentum flavum thickening, and mild bilateral facet joint arthropathy. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. At L2-L3, there is minimal disc bulge, ligamentum flavum thickening, and mild bilateral facet joint arthropathy. There is a left far lateral annular disc fissure. There is bilateral mild neural foraminal narrowing. There is mild narrowing of the spinal canal with effacement of the CSF space anteriorly. At L3-L4, there is mild ligamentum flavum thickening and mild bilateral facet joint arthropathy. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. At L4-L5, there is mild bilateral facet joint arthropathy. There is mild disc bulge without significant spinal canal narrowing. There is mild right and moderate left neural foraminal narrowing. At L5-S1, there is mild bilateral neural foraminal narrowing without disc bulge or narrowing of the central spinal canal.
1. Degenerative changes affect the lumbar spine, without significant spinal canal narrowing. Moderate loss of vertebral body height at the L1 and L3 levels, as detailed above.2. There is no definite evidence of metastatic disease within the lumbar spine. Areas of decreased T1 and T2 signal within several vertebral bodies are of uncertain significance. If further evaluation is desired, nuclear medicine bone scan can be considered.