Clinical question: Multiple myeloma with back pain. Signs and symptoms: As above. Pre-and post-enhanced cervical MRI:Examination demonstrates advanced degenerative disk disease at C3 -- C4 through C7 -- T1 levels.There is no focus of signal abnormality to suggest presence of tumor and there is no detectable abnormal enhancement.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative disk disease and moderate ligamentum flavum hypertrophy. Changes results in mild central spinal stenosis and no neural foraminal compromise.C3-C4 demonstrates advanced disk disease and fusion at the level disk. There is significant right and mild left neural foramina compromise and no definitive central spinal stenosis.C4 -- C5 demonstrate advanced disk loss of disk height and disk effusion at this level. There is significant bilateral neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate advanced disk disease and loss of disk height and broad-based hypertrophic spur. Findings resulting subtle flattening and posterior displacement of the cord and moderate central spinal stenosis. Significant bilateral neural foraminal compromise (right greater than left).C6 -- C7 demonstrate advanced disk disease with significant loss of disk height, mild retrolisthesis, mild hypertrophic changes of posterior elements. Constellation of above findings results in mild central spinal stenosis, moderate bilateral neural foraminal compromise.C7 -- T1 demonstrate advanced disk disease and significant loss of disk height, grade 1 anterolisthesis, mild to moderate ligamentum flavum and severe right and moderate left facet hypertrophic changes. Constellation of above findings results in mild to moderate central spinal stenosis and significant bilateral (right greater than left) neural foraminal compromise.The signal intensity of the cord remains within normal and without evidence of abnormal enhancement.Pre-and post-enhanced thoracic MRI:The examination demonstrates normal anatomical alignment the vertebral column however with mild exaggeration of thoracic lordosis.There is no detectable focus of abnormal signal intensity or enhancement of vertebral column to suggest metastatic disease.The signal intensity of the thoracic cord also remains within normal and without detectable abnormal enhancement. There is subtle increased T2 stir signal change with this finding and with subtle enhancement suggestive of subacute fracture.Mild compression fracture of the superior endplate of T12 with subtle increased T2 stir signal intensity and enhancement which likely indicate subacute fracture.There is moderate to advanced degenerative changes of disks throughout the thoracic spine with multilevel shallow ventral hypertrophic spurs. There is however no evidence of central spinal stenosis at any level. There is also no significant neural foraminal compromise present.The perispinal soft tissues are unremarkable.Pre-and post-enhanced lumbar MRI:The above described mild compression fracture of the T12 superior endplate is concave from C1 inferiorly. However on MRI of lumbar spine counting from below the fracture endplate appears to be at L1 level. This could be result of patient movement.Examination demonstrates fairly extensive degenerative changes of disks and posterior elements.The alignment the vertebral column remains anatomical however there is straightening of lumbar lordosis.Examination demonstrates no focus of marrow signal change or abnormal enhancement to suggest metastatic disease.The signal intensity of the conus and cauda equina also remains within normal and without detectable abnormal enhancement other than expected subtle enhancement of mildly compressed fracture of superior endplate of L1 (counting from below and T12 from counting from above) as detailed above.L1 -- L2 demonstrate extensive degenerative changes however without spinal stenosis. Mild right neural foraminal compromise is present.L2 -- L3 demonstrate advanced disk disease with near complete loss of disk height mild to moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis or significant neural foraminal compromise is present. There is over mild left lateral recess compromise.L4 -- L5 demonstrate advanced disk disease with loss of disk height and advanced bilateral facet and ligamentum flavum hypertrophic changes. Constellation of changes results in moderate to severe central spinal stenosis and significant left and moderate right neural foraminal compromise.L5 -- S1 demonstrate advanced disk disease, loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy. No spinal stenosis. There is however a significant right and moderate left neural foraminal compromise.
1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of metastatic disease. There is extensive degenerative disk disease with resultant minimal grade 1 retrolisthesis at C5 -- C6 and mild grade 1 anterolisthesis at C6 -- C7 levels. There is evidence of central spinal stenosis at C2 -- C3, C5 -- C6, C6 -- C7 and C7 -- T1 levels. There are also multilevel neural foraminal compromise (some significantly) as detailed per level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate no evidence of metastatic disease. There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement. There is no evidence of central spinal stenosis at any level. Mild compression fracture of the superior endplate of T12 with subtle increased T2 stir signal intensity and enhancement which likely indicate subacute fracture.3.Pre-and post-enhanced MRI of the lumbosacral spine demonstrate no evidence of metastatic disease. Extensive degenerative changes of lumber spine results in significant central spinal stenosis at L4 through 5 level as detailed. Note should be made that the above detailed compression fracture of superior endplate of T12 (counted from C1 inferiorly) appears to represent L1 vertebrae when counted from below on MRI of the lumbar spine.