Clinical question: Evaluate for stenosis or myelopathy. Signs and symptoms: Finger and toe paresthesia, back pain, slight bilateral ankle clonus and increased LLE tone. Pre-and post-enhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative changes with resultant moderate left neuroforaminal compromise.C3 -- C4 demonstrate degenerative disk disease with asymmetric ( R > L) uncovertebral hypertrophic changes resulting in significant right and mild left neural foraminal compromise. Mild central spinal stenosis is also present.C4 -- C5 demonstrate moderate disk disease and loss of disk height, mild bilateral (L > R) facet hypertrophy changes. This finding results in significant bilateral (R > L) foraminal compromise.There is a large central and bilateral paramedian disk protrusion resulting in mass-effect, flattening and posterior displacement of the cord and significant central spinal stenosis. There is highly suspected cord increased T2 signal intensity at this level. The signal change of the cord extends inferiorly to approximately the C6 level. At C6 level there is suggestion of decreased cord caliber suggesting myelomalacia. C5 -- C6 demonstrate moderate disk disease and loss of disk height, and mild bilateral facet hypertrophic changes. Findings results in significant bilateral (R > L) neural foraminal compromise. There is a large ventral epidural low signal intensity defect which is a slightly larger on the right and is believed to represent a disk and osteophyte complex. The finding results in mass effect, flattening deformity and posterior displacement of the cord and moderate to severe central spinal stenosis. There is cord T2 signal intensity at this level with decreased cord caliber suggesting myelomalacia. There is posterior longitudinal ligament hypertrophic changes more noticeable at C4 through C6 levels present also.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild bilateral facet hypertrophy changes and no central spinal stenosis. Moderate right and mild left neural foraminal compromise is presentC7 -- T1 is unremarkable.Post-enhanced images are negative for any abnormal enhancement of the cord or the leptomeninges. Is also no detectable abnormal enhancement the vertebral column.Pre-and post enhanced thoracic MRI:T1 -- T2 demonstrate mild degenerative changes of the result in moderate left neural foraminal compromise.T2 -- T3 is unremarkable other than mild degenerative changes.T3 -- T4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T4 -- T5 demonstrate mild degenerative disk disease and mild to moderate asymmetric left facet hypertrophic changes. No spinal stenosis and mild left neural foraminal compromise.T5 -- T6 demonstrate moderate disk disease and loss of disk height small central disk protrusion which results in subtle flattening deformity of the cord without detectable signal abnormality. No spinal stenosis or neural foramina compromise.T6 -- T7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T7 -- T8 demonstrate moderate disk ease and loss of disk height, small central disk protrusion with resultant effacement of the ventral subarachnoid space and subtle flattening deformity of the cord, mild central spinal stenosis and no neural foraminal compromise.T8 -- T9 demonstrate mild degenerative changes without spinal or neural foraminal compromise.T9 -- T10 demonstrate mild to moderate degenerative changes resulting in mild to moderate right neural foraminal compromise.T10 -- T11 demonstrate moderate disk is some loss of disk height, a right lateral small disk protrusion partially extends into the right neural foramina and with resultant moderate stenosis.T11 -- T12 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.T12 -- L1 is unremarkable.Post enhanced images are unremarkable.
1.MRI examination of cervical spine demonstrates extensive degenerative disk disease and to a lesser degree hypertrophic changes of posterior elements. Significant central spinal stenosis and bilateral neural foraminal compromise at C4 -- C5 secondary to degenerative disease and large central disk protrusion. Spinal stenosis and neural foraminal compromise at C5 -- C6 secondary to degenerative disease and a disk osteophyte complex as detailed. Increased T2 signal intensity of the cord extending from mid C4 to mid C6 levels as detailed. Extensive degenerative changes at other levels with multilevel neural foraminal compromise (some significantly) as detailed per level above. Unremarkable post enhanced images.2.MRI examination of thoracic spine also demonstrates extensive degenerative disk disease and to a lesser degree hypertrophic changes of posterior elements throughout the spine. There are small central disk protrusion at multiple levels with resultant mild central spinal stenosis suspected only at T7 -- T8. No detectable cord signal abnormality. Multi-level neuroforaminal compromise as detailed per level above. Unremarkable post enhanced images.