Clinical question: Evaluate for cervical spondylosis. Signs and symptoms: Upper extremity numbness, subjective leg weakness and new hyperreflexia of lower extremity. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.CT-C4 demonstrate mild degenerative disease, bilateral uncovertebral hypertrophy and moderate bilateral ligamentum flavum hypertrophy without significant facet disease. Constellation of changes results in slight flattening deformity of the cord and moderate central spinal stenosis with significant bilateral neural foraminal compromise. There is interval worsening of disease since prior exam.C4-C5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Examination at this level demonstrate a large disc and osteophyte complex in the midline and to the right with resultant mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise. There is also increased T2 signal intensity of the cord consistent with myelopathy. There is progression of degenerative changes at this level since prior exam.C5-C6 demonstrate moderate disc disease and loss of disc height, bilateral uncovertebral hypertrophic changes and mild to moderate bilateral ligamentum flavum hypertrophy. There is significant right and moderate to significant left neural foraminal compromise and mild central spinal stenosis. There is progression of degenerative disease at this level since prior exam.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Hypertrophic spur along the ventral aspect of the canal results in slight flattening of the cord with posterior displacement and mild central spinal stenosis. Significant bilateral neural foraminal compromise is also present.C7-T1 demonstrate moderate disc disease with resultant severe right and mild left neural foraminal compromise and no central spinal stenosis.
1.Interval progression of degenerative disease since prior exam.2.Degenerative changes at C4-C5 and including a large ventral disc-osteophyte complex results in central spinal stenosis and bilateral neural foraminal compromise. There is increased T2 signal intensity of the cord at this level consistent with myelopathy.3.Degenerative changes at C3-C4, C5-C6 and C6-C7 levels also result in varying degrees of central spinal stenosis as mentioned above.4.Multilevel bilateral neural foraminal compromise (several significantly) as detailed per level above.