Inability to walk and poor rectal tone. Evaluate for cord or nerve impingement. There is approximately 60% height loss involving the T12 vertebral body symmetrically compatible with a compression fracture. This is associated with heterogeneously T1-hypointense, T2 hyperintense signal with no significant extension into the posterior elements and is associated with small posterior retropulsion which does touch the spinal cord and causes moderate spinal canal narrowing. However, there is no or very minimal intrinsic T2 hyperintensity within the conus medullaris. There is no soft tissue component in the paraspinal tissues.Multilevel degenerative changes, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is mild diffuse disc bulge, ligamentum flavum thickening, and facet arthropathy resulting in mild spinal canal stenosis. There is also mild to moderate right greater than left neural foraminal stenosis.L5-S1: Diffuse disc bulge, ligamentum flavum thickening, and facet arthropathy moderate spinal canal stenosis. There is moderate right worse in left neural foraminal stenosis with possible impingement, particularly on the right of the L5 nerve roots.The urinary bladder is markedly distended. T1-hypointense, T2 hyperintense renal cortical lesions are probably cysts. There appears to be dilatation of the common bile duct, pancreatic duct, and mildly intrahepatic bile ducts which can be better evaluated with ultrasound. There is also dilatation of the infrarenal abdominal aorta measuring up to 4 cm in the transverse diameter with heterogeneous signal involving the right lateral aspect of the lumen.
1. T12 compression fracture with 60% loss of height with associated moderate spinal canal stenosis and mild impression on the thoracic cord at this level. There may be minimal T2 cord signal abnormality.2. Degenerative changes at the L4-L5 and L5-S1 level with up to moderate L5-S1 spinal canal stenosis and right worse in left L5-S1 neural foraminal stenosis. There may be impingement of the right L5 nerve root.3. Dilatation of the extrahepatic, pancreatic, and mildly the intrahepatic biliary ductal system which can be better evaluated with dedicated ultrasound. There is also aneurysmal dilatation of the infrarenal abdominal aorta which can also be further evaluated with dedicated imaging.4. Markedly distended urinary bladder.Dr. Monther Qandeel discussed the above findings with the neurosurgical team (Dr. Jason Choi) over the phone on August 8, 2015 at 1042 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.