53 year old male with prior cervical spine injury. Evaluate for cervical spine injury. MRI C-Spine:The craniovertebral junction appears within normal limits. There are postsurgical changes of an anterior cervical discectomy and fusion spanning C4-C6. There is also evidence of a prior open door left-sided laminoplasty procedure from C4 through C6. There is straightening of the cervical spine and no evidence of subluxation. There is significant volume loss involving the cervical spinal cord particularly in its mid and lower cervical aspects. Abnormal T2 signal is evident in the cervical cord bilaterally at the C3-C4 level and more pronounced at the C4-C5, C5-C6, and C6-C7 levels. Findings are most consistent with myelomalacia and similar to prior study from 9/21/2010 which was prior to posterior decompression. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations in the cervical spine:C2-3: Right greater than left uncovertebral hypertrophy which contributes to right greater than left mild to moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C3-4: Prominent disc osteophyte complex and prominent uncovertebral spurring. Moderate to severe bilateral neuroforaminal narrowing. Mild to moderate degree of spinal canal stenosis which is slightly less pronounced than priorC4-5: Significant uncovertebral spurring which contributes to severe left and moderate to severe right neural foraminal narrowing. No significant spinal canal stenosis.C5-6: Prominent uncovertebral and facet arthropathy. Moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C6-7: Prominent disc osteophyte complex and facet arthropathy. Moderate to severe, right greater than left, bilateral neuroforaminal narrowing. Mild to moderate spinal canal stenosis which is slightly less pronounced than prior.C7-T1: No significant compromise to the spinal canal or neural foramina.MRI Cord compression protocol:Elsewhere within the spine involving the thoracic and lumbar levels, the vertebral bodies are appropriate in the overall alignment and height aside from straightening of the spinal curvature and mild L5 on S1 retrolisthesis The thoracic spinal cord has gross normal signal characteristics and overall morphology. Within the thoracic spine there are scattered degenerative changes including relatively more prominent disc bulges at the T1-T2 and T9-T10 level but without high-grade spinal canal stenosis or evidence of acute cord compression. These thoracic disc bulges are progressed since prior. Disc height loss at the T9-T10 level is also progressed since prior.There are multiple disc bulges involving the lower lumbar spine as well as prominence of the dorsal epidural fat at the L4-L5 level. There is moderate spinal canal stenoses suspected at the L3-L4, L4-L5, and L5-S1 levels based on the sagittal sequences. There is mild retrolisthesis of L5 on S1. Edematous marrow signal changes are noted at the L5-S1 level which are progressed since prior study from 2010. There is also moderate degree of neural foraminal stenoses from the L3-L4 to L5-S1 levels which appears worse.
1.Extensive myelomalacia involving the cervical cord which was present on prior MRI from 9/21/2010. No clear evidence of cord edema.2.Post-surgical changes of prior anterior instrumentation/fusion and posterior decompression with laminoplasties extending from C4 through C6. There is mild to moderate degree of spinal canal stenosis at the C3-C4 and C6-C7 levels which is slightly less pronounced than on prior.3.Limited cord compression protocol sequences obtained of the remainder of the thoracic and lumbar spine demonstrate no findings to suggest acute cord or acute cauda equina compression. There are however degenerative changes as described above with at least moderate spinal canal stenoses at L3-L4 to L5-S1 which appear worse since prior MRI from 9/21/2010. Dedicated thoracic and lumbar spine images can be obtained for more detailed evaluation as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.