Left back and foot numbness, history of multiple myeloma Five lumbar type vertebral bodies are presumed to be present. There is transitional anatomy at the lumbosacral junction with pseudoarticulation associated with the right lateral L5-S1 junction. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal anterolisthesis at L3 on L4 which is similar to prior. The conus medullaris is normal in position. Diffuse heterogeneity of the bone marrow which may be related to patient's known multiple myeloma is again seen. Compared to 4/18/2014, there is interval development of a 21 x 30 mm T1 hypointense lesion involving the left anterior aspect of the sacrum and without appreciable mass effect on the adjacent sacral neural foramina. There is otherwise no new large lesion in the visualized lumbosacral spine. Cystic lesion at the left S2 level is similar to prior and likely represents a Tarlov cyst.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L3-L4: Grade 1 anterolisthesis and disc uncovering. No significant spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy.L4-L5: Significant disc height loss similar to prior. Bilateral facet arthropathy, advanced on the right. No significant spinal canal stenosis. Mild to moderate neural foraminal stenosis with endplate osteophytes and facet arthropathy narrowing the medial aspect of the facet joints better seen on prior CT from 3/17/2016. L5-S1: No significant disc disease. Bilateral facet arthropathy. No spinal canal or neural foraminal stenosis. Transitional anatomy on the right with pseudoarticulation which is associated with up to moderate stenosis involving the extraforaminal right L5 nerve root.Right kidney not visualized. Left kidney contains a cystic lesion similar to prior.
1. Compared to MRI dated 4/18/2014, there is a new osseous lesion involving the left anterior aspect of the sacrum measuring 2.1 x 3.0 cm, which may be related to myeloma or urothelial cancer. No associated stenosis involving the sacral neural foramina. 2. Multilevel degenerative changes without significant spinal canal stenosis at any level. Mild to moderate neural foraminal stenosis involving the medial aspect of the neural foramina at the L4-L5 level is similar to prior. Neural foramina are otherwise preserved. Additional details as above.3. Unchanged cystic lesion in the left sacrum likely representing a Tarlov cyst.