Increase in falling, evaluate for worsening stenosis Again seen is evidence of basilar invagination/cranial settling with the anterior arch of C1 articulating with the mid dens and the tip of the odontoid process abutting the ventral aspect of the medulla. Odontoid erosions, osseous proliferation anterior to C2 and mild anterior subluxation of C1 on C2 better seen on prior CT. Alignment of the remainder of the cervical spine remains unchanged with mild retrolisthesis of C3 on C4 and minimal retrolisthesis of C4 on C5. There is also trace C7-T1 anterolisthesis. No abnormal cord signal is definitively appreciated. Degenerative changes are seen in the cervical spine as described below:At C2-C3, there is no significant spinal canal or neural foraminal stenosis.At C3-C4, there is is a prominent central disc osteophyte complex as well as ligamentum flavum thickening resulting in moderate spinal canal stenosis and mild cord flattening slightly worse on the left than the right. The stenosis is slightly worse compared to MRI 10/2/2013. No cord signal abnormality. There is bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis.At C4-C5, disc osteophyte complex with mild to moderate spinal canal stenosis. Uncovertebral hypertrophy is associated with moderate right and mild to moderate left neural foraminal narrowing.At C5-C6, there is a small disc osteophyte complex with mild spinal canal stenosis. There is mild to moderate left and mild right foraminal narrowing.At C6-C7, there is a small disc osteophyte complex and uncovertebral hypertrophy with mild to moderate narrowing of the neural foramina. Mild spinal canal narrowing.At C7-T1, there is a small disc osteophyte complex with mild neural foraminal narrowing. There is effacement of the ventral thecal sac resulting in mild spinal canal narrowing.
1. Compared to CT from 8/26/2014, there is no significant change in degree of basilar invagination and cranial settling with mild mass effect of the dens on the ventral medulla. Erosions involving the C1 and C2 levels as well as osseous proliferation related to known rheumatoid arthritis are better seen on prior CT.2. There is moderate degree of spinal canal stenosis at the C3-C4 level with mild flattening of the cervical cord, which is slightly worse since prior MRI from 10/2/2013. No cord signal abnormality is appreciated.3. Additional findings related to multilevel degenerative changes including neural foraminal stenosis as detailed above.