Multiple myeloma, evaluate for disease progression. Again seen is an enhancing lesion involving the base of the dens which appears slightly smaller since remote study from 7/17/2014 and compatible with treated lesion. No evidence of increased osseous destruction. No associated epidural tumor.No other suspicious lesions are evident within the cervical spine to suggest progressive multiple myeloma. There are suspected multiple foci of T2 hyperintensity in the cervical cord such as the left lateral C5 level where there is also volume loss as well as additional levels such as C2-C3 and C4 levels without associated cord expansion or significant volume loss. No associated enhancement. Some of these foci such as the left C5 lesion were evident on prior study from 1/20/2015 while the other foci are not definitively seen. Motion degradation on the STIR sequence limits optimal evaluation.Vertebral body heights in the cervical spine are normal. There is partial ankylosis involving the C4 and C5 vertebral bodies as well as the posterior elements on the left. There is severely diminished disc height loss at the C3-C4 level, which was also present previously. There is moderate degree of spinal canal stenosis at the C2-C3, C3-C4, C4-C5, C5-C6, C6-C7, and to a slightly lesser degree C7-T1 levels.Degenerative changes are seen in the cervical spine as described below:C2-3: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate degree of spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis. Bilateral facet arthropathy, severe on the right.C3-4: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate spinal canal stenosis. There is moderate left and minimal right neural foraminal stenosis.C5-6: Disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is also moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Disc osteophyte complex and mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is also moderate bilateral left worse than right neural foraminal stenosis.C7-T1: Mild disc bulge with no significant spinal canal stenosis. There is mild left neural foraminal stenosis related to facet arthropathy. Right neural foramen is grossly patent. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Enhancing C2 lesion is slightly decreased in size compared to prior exams dating back to 7/17/2014 and compatible with treated lesion. No new or enlarging lesion to suggest progressive multiple myeloma in the cervical spine. 2. Multilevel degenerative changes throughout the cervical spine with up to moderate spinal canal stenosis at multiple levels similar to prior study. There is also multilevel neural foraminal stenosis, up to moderate to severe at the C3-C4 and C5-C6 levels.3. Subtle patchy T2 signal abnormality at multiple levels in the cervical cord, particularly at the left C5 level with there is also volume loss compatible with myelomalacia. Etiology of the signal abnormality is nonspecific but may be related to chronic compression, radiation related injury, or less likely inflammatory/demyelinating process. 