 Exam severely limited due to patient motion. CERVICAL SPINE: Multiple small osseous lesions are again seen in the cervical spine consistent with known multiple myeloma. Example lesions involve the anteroinferior C2 and posterolateral and anteroinferior C5 which are not significantly changed from the previous exam.Lack of contrast somewhat limits evaluation. However, no evidence of epidural mass or cord compression related to tumor is seen. There is moderate spinal canal stenosis at C4-5 and C5-6 and mild canal narrowing at C3-4 and C6-7 related to degenerative disease with disc-osteophyte complexes and ligamentum flavum buckling better seen on prior. Appearance is grossly stable. There is questionable T2 signal abnormality from C4 to C6 which is unchanged. Moderate to severe left C6-7 neural foramen narrowing is similar to prior.THORACIC and LUMBAR SPINE: Multiple small lesions also seen scattered in the thoracic spine. Again seen is a relatively prominent T3 antero-inferior lesion similar to the prior MRI.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. Motion degradation limits evaluation of the epidural tumor. There is however compared to 1/22/2015, significant decrease in extent of epidural soft tissue with thin in residual epidural soft tissue seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is significant interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue through the neural foramen on the right at T12-L1, L1-L2, and L2-L3, again seen. Significant decrease in soft tissue involving the right paraspinous musculature and psoas muscle again noted.No significant spinal canal or foraminal stenosis within the upper and mid thoracic spine.Previously seen T2 hyperintensity and swelling of the distal thoracic cord/conus is improved.Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.
1. Very motion degraded exam of the spine. Compared to 1/22/2015, there is some decrease in extent of epidural soft tissue in the lower thoracic and upper lumbar spine likely related to combination of treatment effect and decrease in hemorrhagic component of the tumor. Residual epidural soft tissue is again seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue again seen extending into the neural foramina on the right at T12-L1, L1-L2, and L2-L3. Decrease in soft tissue involving the right paraspinous musculature and psoas muscle also noted.2. Multiple myeloma with small scattered osseous lesions in the cervical, thoracic and lumbar spine. No large destructive osseous lesions or compression fractures.