65-year-old female with numbness, tingling in the legs. History of myeloma, lumbar polyradiculopathy on the EMG study. 5 lumbar type vertebra are present. Alignment is anatomic. There are no acute fractures or subluxations. Vertebral body heights and disc spaces are maintained. The marrow signal is mildly heterogeneous without evidence of marrow edema. Few scattered areas of subtle STIR hyperintensity, for example within L2 and S1 vertebral bodies, are nonspecific. There are 2 nerve roots (most likely the L4 nerve roots) which, are somewhat thickened and, after originating from the conus, take a position anteriorly within the thecal sac abutting the ventral dura. More inferiorly, these nerve roots return to a more normal dependent position in the thecal sac. There are several additional nerve roots along the cauda equina which appear mildly thickened. L1-2: No significant spinal canal or neuroforaminal stenosis. L2-3: No significant spinal canal or neuroforaminal stenosis. L3-4: Mild disc bulge and ligamentum flavum thickening with associated mild neural foraminal narrowing. No significant spinal canal stenosis. L4-5: Mild to moderate disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy containing bilateral facet effusions. There is mild bilateral lateral recess and moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis. L5/S1: Mild disc bulge and bilateral facet hypertrophy without significant neural foraminal or spinal canal stenosis.
1. Apparent adhesion of some nerve roots to the ventral thecal sac and thickening of other nerve roots could represent sequela of prior arachnoiditis though this is nonspecific.2. Heterogeneous marrow signal without evidence of marrow edema, nonspecific.3. Mild degenerative changes of the lumbar spine as described above. 