 Cervical spine:There is minimal degenerative retrolisthesis of C4 on C5 and C5 on C6, otherwise alignment is within normal limits. There is no evidence of acute fracture. There is extensive multilevel cervical spondylosis with disk space narrowing and central canal stenosis, with level specific findings as follows:C2-3: No significant neuroforaminal or central canal stenosis.C3-4: Disk osteophyte complex results in mild central canal stenosis. Uncovertebral joint hypertrophy results in mild right and moderate left neuroforaminal stenosis.C4-5: Disk osteophyte complex results in severe central canal stenosis without discrete cord signal abnormality. There is severe bilateral neuroforaminal narrowing. There is a small rounded focus of high T2/STIR signal along the posterior-inferior aspect of the C4 vertebral body with questionable enhancement, favored to be degenerative in etiology. C5-6: Disk osteophyte complex results in moderate-severe central canal stenosis without discrete cord signal abnormality. Uncovertebral joint hypertrophy results and mild left and severe right neuroforaminal stenosis.C6-7: Disk osteophyte complex results in severe central canal stenosis without discrete cord signal abnormality. There is severe bilateral neuroforaminal narrowing. Otherwise, there is no pathologic enhancement noted. Sagittal images obtained via the acute cord compression protocol through the thoracic spine are unremarkable. Lumbar spine: There is mild lumbar scoliosis, otherwise alignment is within normal limits. Postoperative changes of laminectomy at L4 and L5 are again noted. A T1 and T2 hyperintense focus in the L2 vertebral body without enhancement is most consistent with a vertebral hemangioma, and likewise smaller foci of T1/T2 hyperintensity also do not demonstrate pathological enhancement. The spinal cord terminates at L1-2. The visualized distal cord and conus medullary as demonstrated normal signal and morphology. There is loss of disk height at L4-5 and L5-S1, with additional level specific findings as follows:L1-2: No significant central canal or neuroforaminal stenosis.L2-3: Right greater than left facet hypertrophy. No significant central canal or neural foraminal narrowing.L3-4: Severe bilateral facet and ligamentum flavum hypertrophy. Mild disk bulge without significant central stenosis. No significant neuroforaminal narrowing.L4-5: Severe facet hypertrophy. Mild disk bulge without significant central canal stenosis. Mild bilateral neuroforaminal stenosis.L5-S1: Severe facet hypertrophy. Mild disk bulge without significant central stenosis. Severe bilateral neuroforaminal narrowing.
1. Severe degenerative cervical spondylosis with severe central canal and neuroforaminal stenosis at multiple levels as detailed above. 2. Small rounded focus of high T2 signal along the posterior-inferior aspect of the C4 vertebral body with questionable enhancement does not have a typical appearance for metastatic disease and is most likely degenerative in etiology. There is no convincing evidence of osseous metastatic disease. 3. Postoperative changes of L4 and L5 laminectomy and multilevel lumbar degenerative changes as detailed above, without significant interval change since 2013. 