Bev56MemberNovember 17, 2012 at 8:24 pmPost count: 2
Good Morning Dr. Corenman. I am a surgical nurse with chronic back pain. I recently had an MRI of the L spine which shows some disturbing impressions:
“Circumferential disc osteophyte complexes with superimposed left foraminal disc protrusion at L2-3 level causing left neural foraminal narrowing. Circumferential disc osteophyte complex, facet degenerative changes, and ligamentum flavum thickening causing bilateral neural foraminal narrowing at L5-S1 low signal intensity lesions are visualized in the L4 and L5 vertebral bodies, which could be related to atypical hemangiomas, however multiple myeloma or metastatic disease cannot be completely excluded. Follow up with Bence Jones proteins and further evaluation with MRI of the lumbar spine with and without IV contrast would be helpful.”
Blood test results showed normal CBC, negative ESR, elevated cholesterol, (don’t we all) and further blood tests have been ordered.
My question is will CRP, LDH, and serum electrophoresis rule out multiple myeloma? And what other tests or treatments would you recommend?
Age 56, 155lbs 5’5, no other real health issues. MVA in 1985 with pelvis fx among other injuries, G4P4, all healthy children, breast CA in mother, living, age 80 living in a nursing home, father age 85 living,very active no CA. 4 siblings alive and well, no sig health issues.
Thank you for this forum. BevRN, MichiganDonald Corenman, MD, DCModeratorNovember 17, 2012 at 9:01 pmPost count: 8468
This would be more accurate from one of my oncology colleagues but I’ll give you my limited understanding. Multiple Myeloma is a disorder of the plasma cells of the bone marrow. These cells usually make the antibodies that fend off infection. A chromosomal abnormality causes one cell line to misbehave, over-multiply and overproduce useless proteins (Bence Jones proteins).
Multiple myeloma is diagnosed by the presence of these abnormal proteins, an abnormal bone marrow biopsy and other evidence of the abnormal presence of plasma cells. I don’t believe that just the presence of Bence Jones proteins confirms that diagnosis but has to be associated with a positive bone marrow biopsy.
Your lower back pain more likely than not is related to the significant degenerative changes of the discs, especially at L5-S1 but you do need to rule out the presence of MM.
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