A bone scan showed increased uptake of the tracer in the shoulders, the cervicothoracic junction, and the L4 and L5 vertebrae. The thecal sac was compressed and displaced posteriorly by abnormal soft tissue that extended from the midbody of the L4 vertebra to the midbody of the L5 vertebra. The radiologist thought that the soft tissue was most likely a herniated disk. The patient received oral morphine sulfate to control his pain. The patient has spinal stenosis on the CT myelogram, but he does not have the clinical findings of pseudoclaudication.
Abnormal findings are very common on imaging of the spine, even in patients who are asymptomatic.
The physician needs to match the imaging results to the patient's symptoms. The patient has a soft-tissue mass interpreted as a herniated disk. When herniated disks do occur in older patients, they are often higher up in the lumbar spine. I am very concerned that this abnormal soft tissue may represent an epidural metastasis rather than a herniated disk. I am not sure what to make of the bone-scanning results.