History of esophageal cancer, status post resection and C3 to C6 anterior-posterior spinal fusion, now with severe neck pain, and likely C6-C7 instability. Again seen are postsurgical changes of partial C4 and C5 corpectomy, placement of cage, and anterior fusion from C3 to C6 with anterior plate and screws. Posterior fusion hardware also seen from from C3 to C6 including posterior rods, screws, and bone graft. Compared to 12/17/2014, there is interval development of lucencies involving the inferior aspect of the C6 vertebral body and the superior aspect of the C7 vertebral body better seen on CT from the same day. The C6 screws are no longer embedded within solid bone. There is loss of the C6-C7 intervertebral disk space with foci of air. There is mild widening of the bilateral C6-C7 facet joints. No significant hardware displacement is appreciated. Mild 4-5 retrolisthesis is similar to prior and better seen on CT.Marrow signal changes involving the residual C4 and C5 vertebral bodies again seen and correspond to sclerosis seen on prior CTs. No prior postoperative MRI is available, however there is diffuse T1 hypointensity and T2 hyperintense marrow signal abnormality involving the C7 vertebral body extending into the pedicle. There is suggestion of T2 hyperintensity in the inferior C6 vertebral body and C6-7 disc space although not well seen due to susceptibility artifact and loss of height. Susceptibly artifact slightly limits evaluation. There is mild to moderate bilateral right worse than left neural foraminal narrowing at C6-C7 and on the right at C5-6 and C4-5. There is mild spinal canal narrowing from C3 to C6 with effacement of the ventral and dorsal thecal sac related to disc material. C6-7 spinal canal narrowing is worse since MRI from 10/14/2014. No cord signal abnormality is appreciated.
1. There are postoperative changes in the cervical spine including C4-5 corpectomy, C3-6 anterior fusion and C3-6 posterior fusion. Compared to CT from 12/17/2014, interval collapse of the C6-7 disc space and lytic changes involving the inferior C6 and superior C7 vertebral bodies noted with some loss of height, worse at C6 than C7; these findings are better appreciated on CT. There are new foci of air and within the C6-7 disc space and widening of the C6-7 facet joints consistent with instability at this level. The inferior C6 screws are no longer surrounded by solid bone. These findings are also better appreciated on the CT.2. There is new, diffuse edema involving the C7 vertebral body and the suboptimally visualized inferior C6 vertebral body and C6-C7 disk space, which while may be on a mechanical basis/instability at C6-7 with associated osseous erosive changes, raises possibility of new infection at the C6-C7 level.3. Mild spinal canal stenosis from C3 to C6 with effacement of the ventral greater than dorsal thecal sac related to disc-osteophyte complexes and postoperative changes. C6-7 spinal canal narrowing is worse since preoperative MRI from 10/14/2014. Contrast sequences may be helpful to better evaluation for infection and epidural extension if there is clinical suspicion. No cord signal abnormality.