Male, 71 years old, with severe spinal stenosis at C6-7 seen on MRI with right-sided neck pain. Status post prior neck fusion from C2 through C4. Evidence of posterior instrumented fusion is seen from C3 through C6, as well as laminectomy and spinal canal decompression from C3-4 to C5-6. The cervical lordosis is reversed. Findings are all similar to that seen on prior CT from 2011.Fusion of the C4 and C5 vertebral bodies is seen with waist-like narrowing at the level of the disc space. There may also be some partial fusion of the C5 and C6 vertebrae. No evidence of marrow edema or pathologic marrow replacement is seen. Artifact from the orthopedic instruments does limit the postcontrast images to some degree, but where evaluable, no evidence of pathologic marrow enhancement is seen.T2 hyperintensity is evident centrally within the cord at the C4 and C5 levels. Morphologically, this appears to represent myelomalacia involving the ventral and mid portions of the spinal cord. The cord is closely positioned to the ventral thecal sac which may indicate scarring or tethering. There are no findings to suggest active cord edema. Visualization of the spinal cord at the C4-5 level on postcontrast images is unfortunately obscured by metallic artifact. Elsewhere, no pathologic spinal cord enhancement is observed.A flap reconstruction of the pharynx is partially visualized.C2-3: Mild facet arthropathy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Fusion across the disc space. Surgical decompression of the spinal canal. Moderate right and mild left neuroforaminal narrowing. C5-6: Perhaps partial fusion across the disc space. Minimal disc bulging and osteophytic ridging. Surgical decompression of the spinal canal. Both neural foramina may be narrowed, but they are not well assessed due to artifact. C6-7: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis without cord deformation. Mild to moderate bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal stenosis.
1.Findings are seen compatible with posterior instrumented fusion and spinal canal decompression. The spinal canal is patent except at C6-7, where a combination of disc degeneration and ligamentum flavum thickening causes mild spinal canal stenosis.2.Spinal cord signal abnormality is seen at the C4-5 level. This appears to represent myelomalacia with perhaps a component of cord scarring or tethering to the ventral thecal sac. No prior MRI examination is available for comparison, but these findings are favored to be chronic in nature. The etiology is uncertain but lesions of this sort could potentially arise from prior cord impingement, prior surgery, ischemia or postradiation effect.