Clinical question: 83-year-old male with multiple myeloma. Presents with low back pain. Rule out bony disease. Evaluate for degenerative disk disease. Signs and symptoms: Moderate to severe low back pain. Constipation. Nonenhanced CT of lumbar spine girl inaxial 3 -mm continuous CT images of the entire lumbosacral spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates severely osteopenic lumbosacral vertebral column. The alignment of the vertebral column is within normal limits. Partially visualized lower T10 vertebrae demonstrate extensive lytic changes which considering patient's history likely represents multiple myeloma. The alignment and morphology the vertebral column from T11 through L5 remains within normal. No evidence of a destructive bony lesion is identified.There is a large irregularly-shaped lytic lesion in the vertebral body of S1 on the left which is also suspected from a myoma. Very large similar lesions within bilateral iliac wings and the ala of the sacrum and is also present.There is no significant degenerative disk disease on this exam. There is mild to moderate degenerative changes of posterior elements of both facets and ligamentum flavum.There is no definitive bony central canal stenosis. There is highly suspected neural foramina compromise bilaterally at at L4 -- L5 level mild neural foramina compromise at L3 -- L4 is also suspected. No definitive neural foramina compromise at any other level.For more detailed evaluation of degenerative disk disease, central spinal stenosis or neural frontal compromise an MRI examination is recommended. MRI can also better visualized the extent of changes of multiple myeloma which due to very severe osteopenia may be difficult to assess on CT.
1.Severe osteopenia results in very poor visualization of bony structures of lumbosacral spine.2.There is a destructive lytic lesion in partially visualized vertebral body of T10.3.Large irregularly-shaped lytic lesion is noted involving the vertebral body of S1. Likely secondary to multiple myeloma.4.Extensive lytic changes of the iliac wings bilaterally (left greater than right cortical and central ala (left greater than right) consistent with patient's history of multiple myeloma.5.Mild degenerative disk disease and hypertrophic changes of posterior elements are noted. No evidence of any bony central canal stenosis. Mild compromise of bilateral neural foramina at L4 -- L5 and to a lesser degree at L3 -- L4 level is suspected.