Female, 61 years old, with low back pain and new compression fracture on x-ray. Thoracic:Compression deformities are seen affecting T8 (60% loss of height) and T11 (40% loss of height). The thoracic spine is mildly scoliotic and the thoracic kyphosis is mildly exaggerated.Bone marrow characteristics are diffusely heterogeneous. There are, in addition, superimposed additional areas of marrow replacement with pathologic enhancement involving the vertebral bodies of T8 through T12. Similar lesions are also seen affecting the right T6 pedicle, the T8 spinous process and laminae, the right T9 pedicle and transverse process, and in the soft tissues adjacent to the T11 spinous process.No significant dural or leptomeningeal enhancement is seen. No intracanalicular masses are detected. The spinal cord shows normal signal intensity and morphology.No significant disk herniations or spinal canal stenoses are seen. The neural foramina are patent.Lumbar:Compression deformities of L1 (50% loss of height) and L4 (40% loss of height) are seen. Again, the spine is mildly scoliotic.Bone marrow signal characteristics are diffusely heterogeneous with more focal areas of marrow replacement affecting the left L2 vertebral body, and the left L3 pedicle and transverse process. All the vertebral bodies demonstrate at least patchy enhancement. The sacrum and iliac bones are also diffusely involved.No evidence of any significant epidural or leptomeningeal spread is visualized. The conus and cauda equina are unremarkable except as discussed below. No pathologic leptomeningeal enhancement is seen.T12-L1: Facet hypertrophy. Mild retropulsion of the compressed L1 vertebral body which effaces the ventral thecal sac. No evidence of nerve root impingement is seen. No significant foraminal narrowing.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate left and mild right neuroforaminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or foraminal narrowing.
Diffuse marrow infiltration is seen with pathologic compression fractures of T8, T11, L1 and L4. Differential diagnosis would include multiple myeloma as well as metastatic disease. Despite widespread osseous involvement, no significant encroachment upon the epidural space or spinal canal is seen.Multilevel degenerative findings are evident in the lumbar spine, most severely affecting L4-5 where there is a moderate to severe spinal canal stenosis.