Multiple myeloma. Evaluate for lesion in the lumbar spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextroscoliosis of the lumbar spine with apex at the L2-L3 level. There is severe loss of disc height at the left L2-L3 level. There is increased edema involving the L2-L3 endplates and enlargement of a Schmorl's node involving the superior L3 endplate. Schmorl's node involving the inferior endplate of L2 is similar to prior. No definite myelomatous lesion in the lumbar spine is appreciated. There is nonspecific heterogeneous bone marrow particularly in the pelvis with areas of T1 hyper and hypointensity similar to prior. The conus medullaris is normal in position.There is mild to moderate facet arthropathy throughout the lumbar spine. Additional details regarding degenerative changes as below: L1-L2: Mild disc bulge. No spinal canal or neural foraminal stenosis. L2-L3: Diffuse disc bulge, eccentric to the left with effacement of the left lateral recess and moderate left neural foraminal stenosis. No significant central spinal canal or right neural foraminal stenosis. L3-L4: Disc bulge, ligamentum flavum thickening, and facet arthropathy. There is mild spinal canal and mild left greater than right neural foraminal narrowing.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are grossly unremarkable.
1. There is nonspecific heterogeneity of the bone marrow as before without definite evidence of myelomatous lesion in the lumbar spine.2. Severe loss of height involving the left aspect of the L2-L3 disc space with associated dextroscoliosis and interval increase in bone marrow edema and endplate irregularity at this level. 3. There is moderate left L2-L3 neural foraminal as well as lateral recess stenosis as before. There is also mild L3-L4 central spinal canal stenosis as before.