New diagnosis of lung cancer with metastasis to L1. New back pain. The marrow is heterogeneous and demonstrates numerous T1-hypointense, STIR-hyperintense, contrast-enhancing lesions that are most consistent with metastatic disease. Both the anterior and posterior elements are involved as well as the included pelvic bones. The most prominent involvement is at the vertebral bodies of L1, L2 and S1 levels. There is also minimal abnormal contrast enhancement in the anterior and left lateral paraspinous soft tissues at the L1 level. No evidence of osseous retropulsion or epidural tumor.There are changes of previous L4 laminectomy. Sagittal alignment is notable for straightening and minimal posterior subluxation of L3 relative to L4. There is mild left-sided L1 and L3 vertebral body height loss/compression fractures associated with rightward convex curvature. There is mild central spinal canal stenosis at L2-L3. The conus medullaris shows no gross abnormality and its termination lies at mid L1 level. There is no abnormal contrast enhancement along the conus medullaris or cauda equina roots.There are few T1-hypointense, T2-hyperintense, non-contrast-enhancing lesions in the kidneys that probably represent cysts but are not completely assessed.T12-L1: There is mild facet arthropathy and ligamenta flava thickening but no significant spinal canal or neuroforaminal stenosis.L1-L2: Mild disc bulge is eccentric to the left resulting in mild narrowing of the left subarticular recess and neural foramen. There is no significant central spinal canal stenosis.L2-L3: Disc uncovering as well as eccentric to the left bulge in addition to mild ligamentum flavum thickening and facet arthropathy result in mild left subarticular recess and mild central canal narrowing. There is no significant neural foraminal stenosis.L3-L4: Disc bulge along with mild-to-moderate facet arthropathy results in moderate left and mild-to-moderate right neural foraminal stenosis but no significant central spinal canal stenosis.L4-L5: Disc bulge along with severe right/moderate left facet arthropathy result in moderate right and mild left neural foraminal stenoses. There is also mild central spinal canal stenosis.L5-S1: Mild disc bulge results in no significant central canal stenosis. There is mild facet arthropathy but no significant neural foraminal stenosis.
1.Diffuse osseous metastasis involving the lumbosacral spine and the included pelvic bones. There is minimal contrast enhancement in the paraspinal soft tissues adjacent to L1 vertebral body metastasis. No epidural tumor.2.Mild left-sided L1 and L3 vertebral body compression fractures. 3.Multilevel spondylosis resulting in mild spinal canal stenosis at L2-L3 and variable neural foraminal stenoses at L3-L4 and L4-L5 as described above.