Myelopathy, spastic paraparesis Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is within normal limits. Limited evaluation of the cervical spine on the sagittal counting sequence demonstrates a low T1 and T2 signal structure dorsal to the C2-C3 disc space which may represent focus of ligamentous calcification or extruded disc material. There appears to be at least mild spinal canal stenosis at this level.At multiple levels in the thoracic spine, there is low T1 and low T2 signal involving the dorsal spinal canal likely representing ligamentum flavum calcifications. These lesions are seen at T2-T3, T3-T4, T4-T5, and T6-T7 levels in the upper thoracic spine without significant spinal canal stenosis. There is however a larger focus which extends from the upper T9 to the upper T10 level which results in moderate to severe spinal canal stenosis and deforms the thoracic cord. There is questionable T2 cord signal abnormality at this level (sagittal T2 and STIR image 10). More inferiorly, mild spinal canal narrowing is seen at T10-T11, moderate spinal canal narrowing at the T11-T12 level, and moderate to severe canal narrowing at the T12-L1 level at the level of the conus related to ligamentous flavum calcifications. Mild foraminal narrowing is seen associated with the aforementioned calcifications. No high-grade foraminal stenosis. No abnormal enhancement. Paraspinous soft tissues are unremarkable.
1. Significant multilevel thoracic spinal canal narrowing related to what likely represents ligamentum flavum calcifications. CT may be helpful to better visualize the extent of calcifications. There is resulting moderate to severe spinal canal stenosis and mild cord deformity extending from the upper T9 to the upper T10 levels. There is subtle cord signal abnormality suspected at this level. 2. There is also moderate to severe spinal canal narrowing at the T12-L1 level and to a slightly lesser degree at the T11-T12 levels. Lesser degrees of spinal canal narrowing related to the ligamentum flavum calcifications as detailed above. 3. No intrinsic cord lesions or masses.