65-year-old male with a history of myeloma, sciatic pain, and a history of a L5 lesion with progression of disease. Evaluate for interval change of the myeloma, sciatica and L5 lesion. There is normal lordotic curvature of the lumbar spine. There is preservation of the vertebral body heights. There is mild multilevel disc desiccation and mild disc height loss involving the L3-4 and L4-5 levels. There is diffuse marrow T1 hypointensity and slight STIR hyperintensity which is unchanged compared to the previous exam and likely related to multiple myeloma.The right inferoposterior L5 vertebral body myelomatous lesion is again visualized and demonstrates eccentric protrusion toward the right L5-S1 lateral recess, also abutting the thecal sac. This has increased in the extent of protrusion compared to the previous exam and further narrows the right L5-S1 lateral recess and neuroforamen causing greater impingement/encroachment on both the exiting L5 nerve root and traversing S1 nerve root. Elsewhere in the lumbar spine from T12-L1 through L2-L3, there is no neuroforaminal narrowing or spinal stenosis. Minimal disc bulging at the L3-4 with a tiny left paracentral protrusion, and broad based disc bulging at the L4-5 level, are unchanged.
1. Interval increase in the protrusion of the myelomatous lesion along the right aspect of the inferoposterolateral L5 vertebral body which is causing increased narrowing of the right lateral recess and right L5-S1 neural foramen with evidence of increased mass effect on both the traversing S1 nerve root as well as the exiting L5 nerve root.2. The remainder of the spondylotic findings within the lower lumbar spine are unchanged.3. Diffuse replacement of normal fatty marrow is likely related to multiple myeloma.