Worsening right arm weakness and tingling. Evaluate for spinal pathology. Craniovertebral junction appears within normal limits. Mild anterior wedging of C4, C5, and to a lesser degree C6 vertebral bodies is stable to minimally worse. Again seen is moderate to severe loss of disc height at the C3-C4, C4-C5, C5-C6, and C6-C7 levels. Associated endplate marrow signal changes are similar to prior aside from minimal worse marrow signal abnormality involving the posterior C6-C7 endplates. Reversal of normal cervical lordosis with kyphosis centered at the C4 level appears worse, although these findings are at least in part positional. Mild retrolisthesis of C3 on C4, C4 and C5, C5 on C6, and C6 on C7 again seen. There is minimal worsening of C6 on C7 retrolisthesis in the interval. No suspicious osseous lesions.There is abnormal T2 signal in the cervical cord at the right C4-C5 level likely reflecting myelomalacia and present previously although more conspicuous on the current study.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: Disc osteophyte complex, kyphosis, and mild retrolisthesis contribute to moderate spinal canal stenosis, which appears minimally worse in the interval. There is also moderate to severe bilateral neural foraminal stenosis. C4-5: Disc osteophyte complex, mild retrolisthesis, ligamentum flavum thickening, and kyphosis contribute to moderate spinal canal stenosis similar to prior. There is moderate to severe bilateral neural foraminal stenosis.C5-6: Minimal retrolisthesis and small disc osteophyte complex with fairly mild narrowing of the spinal canal. There is moderate to severe bilateral neural foraminal stenosis.C6-7: Retrolisthesis with small disc osteophyte complex. The disc component has decreased in the interval. There is no significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.No significant enhancement within the cervical spine aside from related to the degenerative changes. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Enlarged multinodular thyroid gland again seen. Mildly prominent level 1B lymph nodes are noted and are nonspecific, best seen on the axial post gadolinium sequence.
1. Moderate kyphotic deformity and multilevel degenerative changes in the cervical spine have overall slightly progressed since 2/13/2012. Again seen is moderate spinal canal stenosis at the C3-C4 and C4-C5 levels. 2. There is focus of T2 signal abnormality involving the cervical cord at the right lateral C4-C5 level favored to represent myelomalacia.3. Moderate to severe neural foraminal stenoses at the C3-C4, C4-C5, and C5-C6 levels again seen. Additional details as above.4. Mild prominent left level 1B lymph nodes are nonspecific.