70-year-old man with history of multiple myeloma status post stem cell transplant with new onset back pain. The examination is somewhat limited without intravenous contrast. There are numerous low T1 and high T2 signal lesions throughout the axial skeleton, consistent with multiple myeloma. In particular, there is a lesion involving the T9 vertebral body, which demonstrates at least 50% compression deformity with retropulsion of the posterior aspect of the vertebral body into the spinal canal causing severe spinal stenosis and cord compression at this level. There is diffuse edema involving the vertebral body on fluid sensitive sequences suggestive of subacute or acute abnormality. There is approximately 50% compression deformity of the T3 vertebral body without evidence for retropulsion or spinal or neuroforaminal stenosis at this level. There is a lesion within the T10 vertebra with minimal deformity of the superior endplate. There is a lesion with extraosseous soft tissue extension involving the right 10th rib. There is approximately 50% compression deformity of the T11 vertebral body, without evidence for retropulsion or spinal or neural foraminal stenosis. There are additional mild vertebral compression deformities at T3, T8, T10, and T12, without retropulsion. There is no evidence for compression deformity within the lumbar spine, but the L4 vertebral body demonstrates diffusely abnormal marrow signal with small amount of edema likely related to metastatic disease. There is multilevel posterior disc osteophyte complex formation within the cervical spine, worse at C3-C4 level, where there is associated hypertrophy of the ligamentum flavum causing moderate to severe spinal stenosis and moderate bilateral neuroforaminal narrowing. There are posterior disc osteophyte complex formation at C4-T1 levels, with mild indentation upon the spinal cord at C3 though C7 and variable degrees of neural foraminal stenosis. There is a mild diffuse disc bulge at L3-L4 causing mild effacement of the ventral thecal sac however without spinal stenosis or neural foraminal stenosis. There is a mild diffuse disc bulge at L4-L5 causing mild bilateral neural foraminal narrowing. There is a disc bulge at L5-S1, without significant spinal or neural foraminal stenosis at this level. There is no spondylolisthesis. Within the right L3-L4 paraspinal musculature there is a 4.8 x 2.7 cm lobulated low signal soft tissue lesion, which appears to involve the L4 spinous process. There is a 2.8 x 1.7 cm lesion involving the posterior left iliac bone and a 2.6 x 2.3 cm low signal lesion involving the midline occipital bone. There is an additional 3.6 x 1.9 cm lesion involving the right temporal bone. There is a trace amount of fluid in the mastoid air cells. There is a small right thyroid nodule. There is a 1.9 cm diameter right renal cyst.
1. Widespread multiple myeloma throughout the axial skeleton, with a pathological fracture of the T9 vertebral body and retropulsion associated with spinal cord compression at this level. Additional multilevel vertebral compression deformities are not associated with spinal canal or neural foraminal stenosis.2. Multilevel degenerative spondylosis of the cervical spine and lower lumbar spine.Discussed with Dr. Zimmerman at 11: 15 AM on 7/9/16.