Female, 84 years old, with back and hip pain, assess for evidence of metastases and compression. History of lung cancer. A mild levoscoliotic curvature is evident. There are also trace retrolistheses of T12 on L1 and L1 on L2.Mild wedging of the posterior L5 vertebral body is seen with no more than 20% loss of vertebral body height. There may be some loss of height of the left lateral L4 vertebral body as well but this is difficult to ascertain with certainty.Marrow signal characteristics are diffusely heterogeneous. However, within the left posterior aspect of the L4 vertebral body, a fairly broad region of hyperintense STIR and hypointense T1 signal is seen with extension into the left pedicle. Less intense but still noticeable STIR hyperintense signal is seen along the superior endplate of L5 and extending into the left L5 pedicle.The intervertebral disk at L3-4 is mildly STIR hyperintense and there is an associated Schmorl's node deformity along the L3 inferior endplate. The L3-4 endplates demonstrate fatty degenerative signal alteration.Evidence of degenerative disk disease is seen at all levels. Including within the lower visualized thoracic levels. In the lumbar spine, severe loss of disk height is seen at L2-3 and at L4-5. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mildly bulging disk asymmetric to the right. Effacement of the right lateral recess but no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening, particularly on the right. Mild bulging disk. Mild generalized spinal canal stenosis with particular effacement of the right dorsal thecal sac. Moderate right and mild left neuroforaminal narrowing. L3-4: Severe facet hypertrophy and marked ligamentum flavum thickening. Moderate bulging disk. Severe generalized spinal canal stenosis with crowding of the cauda equina. Severe right and moderate left foraminal narrowing. L4-5: Severe left and moderate right facet hypertrophy. Marked ligamentum flavum thickening. Disk bulging and osteophytic spurring asymmetric towards the left foraminal and extraforaminal zones. There may also be bony and/or soft tissue expansion of the left posterior lateral L5 endplate into the left L4-5 foramen. Moderate generalized spinal canal stenosis. Severe left neuroforaminal narrowing with nerve root impingement. Moderate right neuroforaminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk asymmetric to the left. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. Numerous bilateral cystic lesions are seen, some of which are hemorrhagic.
Signal abnormality is seen within the left L4 and to a lesser degree the L5 vertebral bodies. There may be some associated bony and/or soft tissue expansion from the lateral aspects of both vertebral bodies towards the left L4-5 neural foramen which is severely narrowed. Given the history, findings are considered suspicious but not definitive for the presence of metastatic disease. Findings may also reflect severe degenerative edema and/or compression of the left lateral vertebral body. Sequelae of infection would be a much less likely possibility. Given the uncertainty, CT imaging of the lumbar spine may be helpful in better visualizing the bony anatomy and in detecting any underlying osseous lytic process.Moderate to severe degenerative findings are seen at additional levels, for example at L3-4 where there is a severe generalized spinal canal stenosis.