49-year-old male with bilateral burning in the knees in the setting of known diabetic peripheral neuropathy. Lack of sensation out of proportion to diabetes. Evaluate for cause of the neuropathy. C-Spine MRI:There is a peg-like configuration of the right cerebellar tonsil which lies 6 mm below the foramen magnum and is suspicious for a type I Chiari malformation. However, the foramen magnum does not otherwise appear to be significantly crowded. There is abnormal T2 hyperintense and T1 hypointense signal within the central spinal cord at the C4-5 level suspicious for a small syrinx. This lesion measures 2 x 2 millimeters in the axial plane and extends for approximately 13 mm in the craniocaudal dimension.The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. The bone marrow signal is within normal limits. There is mild disc height loss involving the lower cervical spine levels. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3: Left facet arthropathy. Minimal disc bulge without significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a left paracentral and foraminal disc osteophyte and bilateral facet hypertrophy which causes moderate left neural foraminal narrowing. There is no right neural foraminal narrowing or central spinal canal compromise.C6-7: There is a left paracentral and foraminal disc osteophyte and bilateral facet hypertrophy which causes moderate left neural foraminal narrowing. There is no significant right or central spinal canal stenosis.C7-T1: There is a small left greater than right disc osteophyte complex with facet hypertrophy but without spinal canal or neuroforaminal compromise.L-Spine MRI:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is variable disc desiccation and mild disc height loss involving the T12-L1, L1-L2, and L4-5 levels. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: Sagittal view only shows small disc bulge without significant compromise to spinal canal or neural foramina.L1-L2: Small disc bulge without significant compromise to spinal canal or neural foramina.L2-L3: Unremarkable.L3-L4: Disc bulge and bilateral facet hypertrophy and ligamentum flavum thickening, which contribute to mild bilateral neuroforaminal narrowing and moderate spinal canal stenosis with particular narrowing of the right subarticular recess.L4-5: Prominent left greater than right disc bulge with a subarticular and foraminal protrusion which, along with facet arthropathy and ligamentum flavum thickening, contributes to moderate left neuroforaminal narrowing, and mild to moderate spinal canal stenosis with marked left subarticular narrowing.L5-S1: There is no significant compromise to spinal canal or neural foramina.
1. Findings suggestive of Chiari 1 malformation although the CSF space at the level of the foramen magnum is not particularly crowded. 2. A central cord lesion suspected to represent a small syrinx is evident located at the C4-5 level.3. Additional mild spondylotic changes are visualized within the cervical spine without significant spinal canal or neural foraminal compromise.4. Multilevel spondylotic changes involving the lumbar spine most prominent at the L3-L4 and L4-5 levels there is at least some degree of spinal canal compromise