Reason: h/o MGUS and severe lumbar pain, r/o compression fracture vs myeloma lesion vs DDD History: see above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with moderate bilateral facet hypertrophy with ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina at this level. The exiting nerve roots are surrounded by fat within the neural foramina.At L4-5 there is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with bilateral facet hypertrophy at this level. There is mild anterior subluxation of L4 on L5 at this level. There is partial effacement of fat at the lateral recesses at this level. Overall there is mild to moderate spinal stenosis at this level. There is mild narrowing of the neural foramina at this level. The exiting nerve roots are surrounded by fat within the neural foramina. There is minimal progression since the priro exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 3cm cortically based cyst present along the superior pole of the right kidney.There is a 10mm cyst along the inferior pole of the right kidney.
There are degenerative changes in the lower lumbar spine worse at L4-5 where there is mild subluxation and mild to moderate spinal stenosis. There is a slight progression since the prior exam.