Multiple myeloma, sciatic pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights in the lumbar spine are grossly within normal limits. There is mild anterior wedging involving the vertebral bodies at the thoracolumbar junction which can be physiologic versus related to remote mild chronic compression fracture and unchanged since 2012. No edema to suggest a recent compression fracture. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with foci of fat or small hemangiomas. Small Schmorl's nodes involving the endplates at the T11 and T12 levels are also noted. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Small left foraminal annular fissure with small protrusion. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a right paracentral disc extrusion with less than 1 cm of caudal migration. There is contact of the right L5 nerve root in the lateral recesses without clear evidence of impingement. No significant central canal stenosis. There is minimal bilateral neural foraminal narrowing. L5-S1: There is moderate loss of disc height and disc bulge which is eccentric to the left. There is moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis. Possible remote right laminotomy at L5 which can be correlated with surgical history.Paraspinous soft tissues are grossly unremarkable. Small bilateral renal cysts are noted.
1. No discrete multiple myeloma lesions involving the lumbar spine are appreciated. Patient did not wish to proceed with the postcontrast sequences which which limits sensitivity small lesions. 2. Degenerative changes are seen in the lumbar spine particularly at the L4-L5 and L5-S1 level. There is moderate to severe neural foraminal stenosis at L5-S1 where there may be impingement of the exiting L5 nerve roots. There is also a right paracentral disc extrusion at the L4-L5 level which abuts the descending L5 nerve root at this level without clear evidence of impingement.