NSCLC. Brain mets. New gait difficulty and neck pain. Cervical Spine:Alignment is anatomic. Vertebral body height is preserved. Marrow signal shows no suspicious focality. There is mild height and T2 signal loss at C4-C5, C5-C6 and C6-C7 levels. The spinal canal is moderately narrowed at these levels as described below. The spinal cord shows normal signal. The included brain stem and cerebellum show no gross abnormality.C2-C3 and C3-C4: No spinal canal or neural foraminal narrowing.C4-C5: Small disc-osteophyte complex has a central disc protrusion that moderately narrows the spinal canal and appears worse in the interval. There is mild foraminal narrowing.C5-C6: The disc-osteophyte complex has a left paracentral component that indents the spinal cord causing moderate spinal canal narrowing similar to prior. This is associated with relatively severe bilateral uncovertebral productive change and results in moderate bilateral foraminal narrowing.C6-C7: Disc osteophyte complex is associated with bilateral uncovertebral proliferative change. This results in moderate central and bilateral foraminal stenoses.C7-T1: There is no central or foraminal stenosis.Included cervical soft tissues show no gross abnormality. Fluid in the right mastoid air cells can be inflammatory or congestive. Included brain shows no contrast-enhancing mass. Tiny CSF intensity focus involving the undersurface of the left cerebellum may represent a tiny, chronic infarct.Thoracic Spine:Alignment is anatomic. Irregularity along the endplates with small intravertebral herniations of the discs are present at multiple levels but without associated kyphotic deformity. The marrow signal is normal without suspicious focal lesion. The thecal sac is not compressed (tiny anterior indentations by discs are present). The spinal cord shows normal morphology and signal. There is no spinal canal or foraminal stenosis. Dependent atelectasis in the lungs and other findings are better described on the chest CT scan from August 5, 2015.Lumbosacral Spine:Alignment is anatomic. The marrow signal is normal without suspicious focal lesion. The thecal sac is not focally compressed but the lumbar spinal canal is mildly narrowed by short pedicles (congenital narrowing). The conus medullaris has normal morphology and signal characteristics. The tip is at the lower L1 vertebral level. There is no abnormal contrast enhancement along the conus medullaris or nerve roots. Fluid-like signal is present in the subcutaneous tissues of the lower back which is probably dependent edema.T12-L1, L1-L2 and L2-L3: There is no significant spinal canal or foraminal stenosis.L3-L4: Mild ligamenta flava thickening and left more than right facet productive change along with disc bulge result in mild central canal narrowing. There is also mild left subarticular and foraminal stenoses. L4-L5: Disc bulge, ligamenta flava thickening and facet productive change result in mild spinal canal stenoses. There is also bilateral mild foraminal stenoses.L5-S1: There is no significant central or foraminal stenoses.
1.No evidence of metastatic disease in the cervical, thoracic, or lumbar spine. No abnormal enhancement to suggest epidural, leptomeningeal, or, intramedullary tumor2.There is moderate degree of spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels which is stable to slightly worse since 2014. There is flattening of the cord without cord signal abnormality.3.Lumbar spondylosis is mild as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.