Male, 62 years old, with history of multiple myeloma, status post spinal fusion from L2 through L3, with severe DJD. Patient presenting with worsening of pain in the right thigh. Posterior fusion instruments are in place bilaterally at L2-3 along with an intervertebral fusion device. Laminectomy has also been performed at L3 and perhaps partially at L4.Trace retrolisthesis of L1 relative to L2 and L2 relative to L3 are seen. Elsewhere alignment is unremarkable. Vertebral body heights are preserved.Marrow signal characteristics are generally somewhat heterogeneous. Superimposed on this, however, are a 13 mm enhancing lesion within the S2 vertebral body and an 18 mm enhancing lesion within the left iliac bone.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intrathecal enhancement is observed.L1-2: Mild left facet arthropathy. Loss of disc height with mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L2-3: Left facet arthropathy. Minimal residual disc bulging or osteophytic ridging. No significant spinal canal stenosis though the right lateral recess is slightly narrowed. Mild bilateral foraminal narrowing. L3-4: Bilateral facet arthropathy. Disc bulging asymmetric to the right with a focal component encroaching on the right neural foramen. There is also a small right paracentral inferiorly directed extrusion. No significant generalized spinal canal stenosis but the right lateral recess is narrowed. Severe right foraminal narrowing with probable nerve root impingement. Mild left foraminal narrowing. L4-5: Bilateral facet arthropathy. Minimal disc bulging. No significant generalized spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging with a small extrusion projecting towards the right neural foramen. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.
1.Postoperative findings compatible with instrumented fusion of L3-4.2.Focal marrow space lesions within the S2 vertebral body and in the left iliac compatible with multiple myeloma. Diffuse mild heterogeneity of the marrow signal characteristics is nonspecific.3.Multilevel degenerative findings are demonstrated without any areas of high-grade spinal canal stenosis. However, at L3-4, the right neural foramen is severely narrowed with likely nerve root impingement secondary to a disc protrusion.