Rule-out progression of spondylosis after decompressive surgery. History of C5-C6 ACDF in 2000 and C3-C4, C4-C5, C5-C6 laminotomy with C3-C4 diskectomy and July 2013. Residual myelopathy. Intermittent neck pain radiating to bilateral upper extremities. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height with evidence of osseous fusion involving the C5 and C6 vertebral bodies. There is minimal retrolisthesis of C4 and C5. Alignment is otherwise maintained. There is T2 hyperintensity involving the C4 and C5 vertebral bodies which are likely on a degenerative basis.Again seen is abnormal T2 hyperintensity within the cervical cord at C3-C4, C4-C5, and C5-C6 levels with associated volume loss consistent with myelomalacia. Compared to 6/20/2013, interval decompression of the spinal canal is seen from C3 to C5. Diskectomy at C3-C4 is also seen. No significant residual spinal canal stenosis is demonstrated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Interval discectomy. No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing worse on the left.C4-5: Small disc osteophyte complex again seen. No significant compromise to the spinal canal. Moderate to severe right and moderate left neural foraminal narrowing related to uncovertebral hypertrophy. C5-6: No significant compromise to the spinal canal. Minimal left foraminal narrowing. Dorsal ligamentum flavum thickening effaces the dorsal thecal sac. C6-7: No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing.C7-T1: Mild disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild left neural foraminal narrowing.Small disc bulges in the upper thoracic spine again seen. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Compared to 6/28/2013, interval discectomy at C3-4 and decompression of the spinal canal from C3 to C5 is seen. No significant residual spinal canal stenosis is appreciated.2. Again seen is abnormal T2 hyperintensity at C3-C4, C4-C5, and C5-C6 and consistent with myelomalacia.3. Multilevel neural foraminal narrowing again seen as detailed above, worst at C4-5 and similar to prior.