80 year old female with new neuropathy, possible relapse. History of multiple myeloma; recurrence of M protein. CERVICAL SPINE: There is grade 1 retrolisthesis of C5 on C6. There is grade 1 anterolisthesis of C4 on C5 which is slightly increased in prior MR study, as well as stable grade 1 anterolisthesis of C7 on T1. Marrow signal is benign. Focal lesion along the posterior aspect of C7 vertebral body which demonstrates increased T1 and T2 signal which is stable dating back to 2012 and most likely represents a benign hemangioma or area of focal fat.The craniocervical junction and ligamentous structures are maintained. There is abnormal signal intensity of the spinal cord. Multilevel degenerative changes including uncovertebral hypertrophy, mild disc osteophyte complexes with uncovering of the disc at levels of subluxation, ligamentum flavum and facet hypertrophy appear similar. There is up to mild to moderate central spinal canal stenosis at C4-C5. There is moderate left and mild right neural foraminal stenosis at C6-C7 and C7-T1.THORACIC SPINE:Alignment is maintained. There is chronic compression deformity of T8 vertebral body with near complete loss of vertebral body height present at least since 2014 with mild associated enhancement and associated retropulsion of the vertebral body by approximately 4 to 5 mm. There is acute kyphosis of the thoracic spine at this level. There is increased signal and enhancement along the anterosuperior aspect of T9 which is likely degenerative, related to the aforementioned kyphosis. There is stable anterior wedging and persistent focal concavity along the superior endplate of T7 relating to a Schmorl's node. Other than the T8 vertebral body fracture related enhancement, there are no other areas of abnormal marrow enhancement elsewhere. Cord signal is unremarkable.There are multilevel degenerative changes including facet and ligamentum flavum hypertrophy. At T7-T8 there is uncovering of disc with superimposed disc bulge accentuated by the retropulsion of T8; there is associated bilateral moderate neural foraminal stenosis as well as mild to moderate spinal canal stenosis at this level. There is bilateral moderate to severe neural foraminal stenosis and at least moderate spinal canal stenosis at T8-T9. There is moderate to severe left-sided neural foraminal stenosis at T11-T12 which is stable.LUMBAR SPINE:Re-demonstration of extensive hardware artifact related to posterior spinal fusion spanning L2-L5. Cord signal intensity is unremarkable, specifically the conus medullaris on sagittal imaging is grossly intact. Five lumbar type vertebral bodies are presumed to be present. There are multilevel compression deformities and associated Modic type endplate changes, specifically involving L2, L3 and L4 with slightly progressed vertebral body height loss at L4 measuring 9 mm on the current study, previously 16 mm at the thinnest portion of the vertebral body. There is associated mild retropulsion of the L4 vertebral body fracture fragments. There is stable grade 1 anterolisthesis of L4 on L5. Besides the aforementioned endplate Modic typic changes, there is no abnormal marrow signal elsewhere.There are multilevel degenerative changes including disc osteophyte complexes, ligamentum flavum and facet hypertrophy.At L1-L2, there is moderate bulging of the disc with a foraminal component on the right associated with moderate right-sided neural foraminal stenosis. There is moderate to severe spinal canal stenosis at this level which has progressed from prior study.At L2-L3, there is mild spinal canal stenosis related to postoperative decompression.At L3-L4, there is mild to moderate bilateral neural foraminal stenosis, left greater than right.At L4-L5, there is uncovering of the disc with superimposed disc bulge and focal disc material within the left foramen resulting in associated moderate to severe left foraminal stenosis. There is also mild to moderate right-sided neural foraminal stenosis.At L5-S1, there is mild bilateral neural foraminal stenosis.Evaluation of the spinal canal from L3 to S1 is obscured by hardware artifact.There is a focal cystic lesion within the right kidney measuring up to 9 mm.
1. There is no definite evidence of active myelomatous disease.2. Chronic moderate-severe compression deformity of T8 with retropulsion of fracture fragments intervening to overall moderate central spinal canal stenosis at T8-T9. Slight interval progression of moderate chronic compression deformity of L4 with mild retropulsion.3. Multilevel degenerative changes which overall appear progressed in the lumbar spine as described above. Up to moderate to severe left foraminal stenosis at L4-L5 and moderate-severe central spinal canal stenosis at L1-L2. Bilateral moderate to severe foraminal stenosis at T8-T9, as well as moderate to severe left foraminal narrowing at T11-T12.