Reason: 63yo M h/o spina bifida with tethered cord and chronic pain, s/p intrathecal pain pump presenting with acute LE pain and weakness. Also fever; please eval for fluid collection/signs of infection around pump History: BLE weakness, pain. Cervical:There is mild reversal of the normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The cerebellar tonsils are again seen to extend approximately 3 mm below the level of the foramen magnum. There is again prominence of the central canal throughout the cervical and thoracic spinal cord. There is again seen partial fusion of the C3-C4 intervertebral disc. There is a hyperintense lesion in the C6 vertebral body again identified, likely representing a benign hemangioma.Thoracic:There is a normal thoracic kyphosis. The spinal alignment is anatomic and the vertebral body heights are preserved. There are no spinal cord signal abnormalities.The previously noted marrow edema within the T4, T10, and T11 vertebral bodies has decreased. There is increased fatty marrow signal involving several levels of thoracic vertebral bodies. As noted before there is a large anterior bridging osteophyte complex across these vertebral bodies. The T1/T2 dark band traversing the anterior inferior corner of the T11 vertebral body is unchanged compared to prior examinations and corresponds to a sclerotic band on CT.As above, prominence of the central spinal canal begins in the cervical region and continues to the T1-2 level. Intermittent mild prominence of the central canal begins again at the T3-4 level and continues to approximately the T7-8 level, unchanged. As before, the spinal cord is somewhat diminutive, particularly at lower levels. Postoperative scarring is seen within the soft tissues of the lower thoracic region and there is evidence of surgical deformity of the posterior elements at T9-10.An intrathecal catheter is seen entering at the T9 level and extends cranially, terminating at the T4-T5 disc space, unchanged in position compared to prior exam.Lumbar:There is normal lumbar lordosis. The L5 vertebral body demonstrates a mild transitional morphology. There is no abnormal spinal cord signal. The bone marrow and endplates demonstrate a normal MR appearance. Absence of posterior elements is redemonstrated at L4 and from L5 through the sacrum region, possibly of congenital or surgical etiology. The spinal cord remains low-lying, descending at least to the L5 level ultimately thinning and fanning out and blending with a network of soft tissue strands which traverse the lower thecal sac. These findings are unchanged. Degenerative changes are specified by the intervertebral level as follows: C2-C3: No neuroforaminal narrowing or spinal stenosis. C3-C4: There is a disc osteophyte complex with posterior fusion, resulting in left greater than right paracentral and foraminal narrowing. There is unchanged mild to moderate left foraminal stenosis at this level. There is similar effacement of the left ventral cecal sac and mild flattening of the spinal cord.C4-C5: There is similar hypertrophy of the ligamentum flavum and posterior disc osteophyte complex at this level. There is moderate to severe central canal stenosis without spinal cord signal changes, worse on today's exam, however may be related to motion degradation. There is left greater than right facet hypertrophy.C5-C6: There is left greater than right facet hypertrophy and posterior disc osteophyte complex, with worsening left moderate to severe foraminal narrowing and unchanged mild right foraminal narrowing. There is mild central canal narrowing at this level.C6-C7: There is a small posterior disc osteophyte complex without significant neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis. T11-T12: There is moderate left foraminal stenosis and possible disc osteophyte complex at this level, unchangedT12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with unchanged severe central canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with unchanged moderate spinal canal stenosis and mild bilateral foraminal stenosis. L4-L5: There is bilateral facet hypertrophy. There is diffuse disc bulge with central protrusion. No central canal stenosis. There is unchanged mild bilateral foraminal narrowing.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.
1. Degenerative changes of the cervical and lumbar spine as detailed above, with possible interval worsening of C4-C5 central canal stenosis, now moderate to severe.2. Improved bone marrow edema compared to prior exam.3. Unchanged epidural catheter without evidence of adjacent fluid collection or abscess.4. Stable low lying cerebellar tonsils.5. Prominence of the central canal of the spinal cord beginning in the cervical region and continuing in discontinuous fashion through the thoracic region are unchanged.6. Low lying spinal cord which continues at least to the L5 level where it begins to thin and fan out, ultimately terminating in a network of soft tissue strands which traverse the lower thecal sac, unchanged.