 Cervical Spine: There is no significant change in appearance of the craniocervical junction including 7 mm inferior displacement of cerebellar tonsils through a foramen magnum, retroverted odontoid, and postoperative changes. CSF space posterior to the cerebellar tonsils is preserved. Partially imaged brain also demonstrates dysplastic corpus callosum with abnormal T2 hyperintensity better assessed on prior dedicated brain MRI. Ventriculostomy catheter is partially imaged. Lateral ventricles are not well assessed but appear decompressed. There is preserved biphasic flow ventrally at the foramen magnum with diminished flow dorsally at the foramen magnum and upper cervical canal, similar to prior CSF flow study from 9/28/2012.The cervical spinal cord has normal signal characteristics and overall morphology aside from trace prominence of the central canal at the C2 level which is not appreciably changed since 4/26/2014.As before, there is straightening of the normal cervical lordosis which may be positional. The cervical vertebral bodies are appropriate in overall alignment and height. No spinal canal or neural foraminal stenosis at any level. Thoracic Spine: The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is no evidence of syrinx. Lumbar Spine: There are postoperative changes related to myelomeningocele repair and cord untethering. Laminectomy changes are again seen from L3 to S1 level, although there is likely also a component of preceding congenital posterior element dysplasia. The lumbar spine is normal in overall alignment and height. There is partial lumbarization of S1 vertebral body. The conus medullaris/distal neural tissue is low lying and terminates at L3 and abuts the posterior dura as before. Prone images demonstrate no appreciable ventral motion. Distal nerve root clumping also not significantly changed. There is no significant compromise to spinal canal or neural foramina. Small focus of fluid is again seen posterior to the left L3-L4 facet joint measuring 9 x 11 mm in the AP and transverse dimensions and is slightly increased in size. There is moderate degree of facet arthropathy at the L4-L5 level similar to prior to a milder degree more superiorly and inferiorly.
1.Unchanged appearance of the decompressed craniocervical junction including 7 mm inferior displacement of the cerebellar tonsils as well as diminished biphasic flow dorsally at the foramen magnum and upper cervical canal.2.Stable mild prominence of the central canal at C2. Otherwise, no cord signal abnormality to suggest new or enlarging syrinx. 3.Postsurgical changes in the lumbar spine related to prior myelomeningocele repair and cord untethering again seen. Unchanged appearance of the conus/ distal neural tissue which abuts the dorsal dural margin. No appreciable ventral motion is seen on the prone sequences which is unchanged. Cord re-tethering cannot be excluded and suggest correlation with clinical findings. Distal cauda equina nerve roots also abut the dorsal and lateral dural margins which may indicate arachnoiditis but also unchanged.4.Facet arthropathy in the lower lumbar spine is again seen. There is a small focus of fluid, presumed synovial cyst, posterior to the left L3-L4 facet joint which is slightly larger since 4/26/2014.