Female, 63 years old, with multiple myeloma and acute back pain, concern for progressive disease. Numerous foci of marrow replacement with corresponding enhancement are seen throughout the visualized spine. Most of these lesions are on the order of 1 cm in size, but larger lesions are evident within the left lateral mass of C1 and particularly the right sacrum. The sacral mass encroaches upon the right sided foramina and the sacral spinal canal to a mild degree. Elsewhere, no significant epidural disease spread is seen. The spinal canal demonstrates normal signal intensity and morphology throughout and is free of pathologic enhancement.Cervical alignment is anatomic and vertebral body heights are preserved. Disc osteophyte formation is present at multiple levels, most notably affecting the C5-6 level where the left ventral spinal canal is slightly effaced and the left neural foramen is narrowed.The thoracic kyphosis is slightly exaggerated likely due to numerous moderate compression deformities and/or areas of endplate concavity. Loss of vertebral body height has progressed at T9. Evidence of kyphoplasty is seen at T12. Mild disc degeneration is evident at lower thoracic levels without significant spinal canal compromise. The neural foramina are patent.Lumbar alignment is within normal limits. Endplate concavity at L2-L4 results in mild loss of vertebral body height. Mild disc bulging is evident at all levels as well as facet arthropathy at lower lumbar levels. However, no significant compromise of the spinal canal or neural foramina is seen.
Diffuse myelomatous involvement of the spine is seen. In most cases, the myelomatous deposits are small and on the order of 1 cm in size. Larger lesions are evident in the left lateral mass of C1 and particularly in the right sacrum. The sacral lesion encroaches upon the right sided sacral neural foramina and the right sacral spinal canal to a mild degree. Elsewhere no significant tumoral encroachment on the spinal canal is demonstrated. The spinal cord remains within normal limitsCompression deformities and loss of vertebral body height are evident at numerous levels in the thoracic and lumbar spine. Evidence of kyphoplasty at T12 is seen.