Female, 35 years old, with history of Chiari with syrinx, presenting with worsening back pain. Assess for changes. The cerebellar tonsils descend 6 to 7 mm below the level of the foramen magnum. However they maintain a normal round contour and the CSF space at the foramen magnum is circumferentially patent. Robust biphasic CSF flow is seen both dorsally and ventrally through the foramen magnum.No evidence of abnormal signal or syrinx is seen in the cervical spinal cord. In the thoracic cord, very slight prominence of the central canal measuring no more than 1 mm in diameter is seen beginning at approximately T3 and continuing down to T11. The appearance is similar to prior. No abnormalities of the conus or cauda equina are seen. No intraspinal fatty material is detected.The cervical lordosis is mildly reversed similar to prior. Alignment in the remainder of the spine is unremarkable. The vertebral bodies demonstrate normal morphology and signal characteristics. No evidence of marrow edema is detected.At C5-6, disc osteophyte formation is seen with a focal right foraminal protrusion which seems to have increased in size since the prior examination. There is progressive moderate right foraminal narrowing. No significant generalized spinal canal stenosis is seen. The left foramen is patent.At C6-7, disc osteophyte formation is seen with a left foraminal disc protrusion. This appears relatively similar to the prior examination. There is a mild generalized spinal canal narrowing and moderate left foraminal narrowing. The right foramen is patent.Elsewhere in the spine, no significant disc disease, canal stenosis or foraminal narrowing is seen.
1. Findings are redemonstrated compatible with Chiari malformation. The cerebellar tonsils do, however, maintain a normal contour and the CSF space is circumferentially patent through the foramen magnum.2. Minimal prominence of the central spinal canal is seen in the thoracic region showing no significant change. This can reflect normal variation, though in the appropriate clinical context, can also represent minimal syrinx formation.3. At C5-6, there appears to be progression of a right foraminal disc protrusion with slightly worsened foraminal narrowing.4. At C6-7, a disc protrusion in the left foramen is similar to the prior exam.