Evaluate for degenerative disc disease and look for lytic lesions from multiple myeloma. There are T2 hyperintense and T1 hypointense lesions within the left iliac bone and sacrum, the largest of which measures up to approximately 3 cm. There is also a T1 and T2 hyperintense lesion within the T12 vertebral body that suppressed on STIR, which likely represents a hemangioma. At L1-L2, there is facet hypertrophy, but no spinal canal or neural foraminal stenosis. At L2-L3, there is a mild disc bulge and moderate facet hypertrophy without significant spinal canal or neural foraminal stenosis. At L3-L4, there is extensive facet arthropathy, with a new right extradural centrally T2 hyperintense lesion with T2 hypointense rim that measures up to approximately 2 cm and impinges upon cauda equina nerve roots. At L4-L5, there is facet arthropathy and a disc bulge without significant neural foraminal or spinal stenosis. At L5-S1, there is loss of disc space height and a disc bulge associated with effacement of the left lateral recess, as well as moderate right and severe left neural foraminal stenosis. There is grade 1 anterolisthesis at L4-5 and grade 1 retrolisthesis at L5-S1. There is a Schmorl node in the superior L1 vertebral body. The vertebral body heights are otherwise preserved. The paraspinous soft tissues are unremarkable.
1.A new right extradural lesion at the level of the L3 vertebral body likely represents a facet cyst associated with severe facet arthropathy and resulting in cauda equina nerve root compression.2.Multilevel degenerative spondylosis, which is most pronounced at L3-4 and L5-S1.3.Lesions within the left iliac bone and sacrum likely represent myelomatous involvement, although these are incompletely characterized due to the lack of intravenous contrast. 