Difficulty walking, limited range of motion. Patient also has history of lumbar stenosis. Cervical: Examination is slightly motion degraded. Vertebral body heights in the cervical spine are normal. There is exaggeration of the normal cervical lordosis from C2 to C4 and and mild anterolisthesis of C3 on C4 and C4 and C5. There is mild to moderate spinal canal stenosis at C3-C4 with effacement of the ventral and dorsal thecal sac. No cord signal abnormality seen. Osseous fusion involving the posterior elements at C2-C3 and C4-C5 on the left which is likely on a degenerative basis.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant spinal canal stenosis. There is moderate left neural foramina stenosis related to uncovertebral hypertrophy and facet arthropathy. No significant right neural foramina stenosis.C3-4: There is mild anterolisthesis and small central disk protrusion. There is mild ligamentum flavum thickening dorsally. There is mild to moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sac at this level. There is moderate to severe left neural foraminal narrowing related to left-sided facet arthropathy and uncovertebral hypertrophy. There is mild distention of the left facet joint. No cord signal abnormality.C4-5: No significant spinal stenosis. There is intervertebral disk calcification better seen on CT. There is severe left foraminal stenosis. No significant right foraminal narrowing.C5-6: No significant compromise to the spinal canal or right neural foraminal narrowing. There is moderate left neural foraminal stenosis.C6-7: Small disk osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foramina narrowing and minimal right neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow void is diminished which may be related to proximal stenosis. Paraspinous soft tissue structures appear within normal limits.Lumbar:There are 5 lumbar type vertebral bodies. Severe multilevel degenerative changes are again seen which are similar to prior, with prior exam limited by motion degradation. Mild endplate compression deformities of L2 and L3. Severe (approximately 50%) loss of vertebral body heights at L4. There is no associated increased T2 signal to indicate a recent compression fracture. No interval also vertebral body height compared to 8/20/2014. There is grade 1 retrolisthesis of L2 on L3. Facet arthropathy affects the entirety of the lumbar spine and is most severe at L4-5. Note is made of fatty atrophy of the lower lumbar paraspinal muscles. The bone marrow is diffusely heterogeneous. The conus medullaris terminates at the L1 level. There is mild apparent clumped appearance of the nerve roots at multiple levels which is likely related to extrinsic canal stenosis.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Diffuse disk bulge asymmetric to the right. Minimal left and moderate right neuroforaminal stenosis. No spinal canal stenosis.L2-L3: Diffuse disk bulge with a central disk protrusion that in conjunction with ligamenta flava thickening creates moderate spinal canal stenosis. Moderate left and severe right neuroforaminal stenosis.L3-L4: Mild disk bulge and thickening of the ligamentum flavum. Mild to moderate spinal canal, mild left neuroforaminal stenosis, and mild to moderate right neuroforaminal stenosis. L4-L5: Diffuse disk bulge and ligamentum flavum thickening creates mild spinal canal and mild to moderate bilateral neuroforaminal narrowing.L5-S1: Central disk protrusion. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.There is mild atrophy involving the paraspinous musculature. Paraspinous soft tissues are otherwise unremarkable.
1. Multilevel degenerative changes in the cervical spine relatively worse at C3-C4 signal changes effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. No cord signal abnormality. There is mild anterolisthesis at this level. Prominent facet arthropathy and osseous fusion on the left at C2-C3 and C4-C5 are better seen on recent CT.2. There is multilevel neural foraminal narrowing at multiple levels particularly on the left as detailed above and better assessed on CT from 8/20/2014.3. Degenerative changes affect the lumbar spine most notably at L2-3 and L3-4 where there is up to moderate spinal canal stenosis. There is severe right L2-3 neuroforaminal stenosis. No significant change since 8/20/2014.4. Multiple chronic-appearing compression deformities in the lumbar spine. No interval loss of height compared to 8/20/2014 or bone marrow edema.