Radicular pain in the left upper extremity and neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign including a T2 hyperintense lesion involving the C4 vertebral body which is favored to represent an atypical hemangioma and similar to prior.Degenerative changes are seen are again seen the cervical spine, as described below, and have progressed since 8/15/2009:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a central disc extrusion which is larger than prior and associated with moderate spinal canal stenosis and mild deformity of the cervical cord in the midline and to the right of the midline. No significant neural foraminal stenosis. Subtle T2 hyperintensity suspected in the cervical cord which is new/increased since prior.C4-5: There is severe spinal canal stenosis at this level related to disc extrusion and ligamentum flavum thickening which have progressed since prior with increased flattening of the cord with subtle T2 signal abnormality. There is mild to moderate right neural foraminal stenosis and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C5-6: There is right paracentral disc protrusion which appears slightly worse than prior. There is mild to moderate spinal canal stenosis. There is minimal right and no left neural foraminal stenosis.C6-7: Minimal degenerative changes. No significant compromise to the spinal canal or neural foramina.C7-T1: Minimal degenerative changes. No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
Interval progression of multilevel degenerative changes compared to prior study from 2009. There is severe spinal canal stenosis at C4-C5 and and to a lesser degree at C3-C4 and C5-C6 levels primarily related to disc extrusions. There is abnormal T2 hyperintensity in the cervical cord at the C3-C4 and the C5 levels which is worse since prior. There is mild left C4-C5 neural foraminal narrowing; otherwise no high-grade left-sided neural foraminal stenosis is appreciated. Please see additional details above.