Diagnosis: Multiple myeloma, without mention of having achieved remission Closed fracture of unspecified boneClinical question: acuity of compression fractureSigns and Symptoms: back pain MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of compression fractures at T5 (40%), T8 (60%), T11 (30%), T12 (20%) and L1 (60%). The patient is status post kyphoplasty at T11, T12 and L1. Compared to the prior exam there is no interval progression.There is a focus of enhancement identified along the T10 spinous process which was also present on the prior exam and is unchanged. Another focus of enhancement is present along the right posterior elements of T9. It currently measures 16 x 11 mm and previously measured 18 x 11 mm.There is predominantly low marrow signal on T1-weighted images throughout the thoracic spineLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is approximately 30% compression of the L5 vertebral body which is new since the prior exam. There is associated contrast enhancement within the L5 vertebral body which appears to be new compared to prior exam.There are multiple marrow replacing foci identified in the lumbar spine. One along the left posterior elements of L3 was also present on the prior exam and is changed character but appears a little bit smaller. It previously measured 29 x 20 mm sagittal dimensions and now measures 20 mm x 14 mm sagittal dimensions.. Similarly 1 along the posterior aspect of the L2 vertebral body appears to be old but smaller. In general the marrow signal is heterogeneous in appearance.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level there is mild encroachment of the left-sided exiting nerve roots at this level.At L4-5 there is diffuse disc bulge associated bilateral facet and ligamentum flavum hypertrophy. Overall there is a moderate degree of spinal stenosis present at this level. There is also narrowing of the neural foramina with mild encroachment of the exiting nerve roots which is worse on the right side compared to the left. There is some mild encroachment of the right-sided exiting nerve root at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is disc desiccation present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is disc desiccation present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is enlarged but incompletely imaged.
1.There is a moderate degree of spinal stenosis present at L4-5. This was also present on the prior exam and has not changed substantially.2.Since the prior exam from 2/15 a compression fracture has developed a new compression fracture at L5 which is subacute.3.There are multiple compression fractures present in the thoracic spine and at L1 which are stable since the prior exam from 8/15.4.The patient status post kyphoplasty is at T11, T12 and L1.5.There are multiple enhancing lesions throughout the lumbar spine and thoracic spine which are compatible with patient's diagnosis of multiple myeloma. Some of these appear smaller on the current exam compared to the prior exams.6.The uterus is large but not completely included on this exam. Please correlate with patient's clinical history and findings