Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: h/o Multiple Myeloma; new onset low back pain, >1 year since prior imaging, please compare to prior imaging. History: h/o Multiple Myeloma; new onset low back pain, >1 year For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multiple variable sized enhancing vertebral body lesions throughout lower thoracic, lumbar and sacral vertebral bodies as well as right ilium indicate multiple myeloma involvement.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level.There is no evidence of cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: AP diameter of spinal canal appears to be slightly shorter than usual (9.7mm) minimal bulging of disc with bilateral ligamentum flavum thickening results mild spinal canal stenosis.L3-L4: AP diameter of spinal canal appears to be slightly shorter than usual (8.5mm), diffuse bulging of disc with ligamentum flavum thickening results moderate spinal canal stenosis. L4-L5: diffuse bulging of disc associated with broad based eccentric disc bulging toward right neural foramen narrows right neuroforamen. L5-S1: diffuse bulging of disc, otherwise unremarkable.
1. Multifocal bony involvements of known multiple myeloma including lower thoracic, lumbar, sacral and right ilium as described above.2. No evidence of vertebral compression fracture. Spinal cord signal intensity is normal.3. Multifocal degenerative changes of lumbar spine. Especially at the level of L34 and L45, there are mild not moderate degree spinal stenosis. 4. Shorter AP diameter of L34 and L45 spinal canal suggest associated possible congenital spinal canal stenosis.