Clinical question: Left arm tingling and left leg weakness and hyperreflexia Signs and symptoms: As above. Nonenhanced cervical MRI: There is normal signal intensity and anatomical alignment of vertebral column.There is normal signal intensity and caliber of cervical cord.There is mild degenerative changes of cervical spine without central spinal stenosis. There is mild to moderate right neural foraminal compromise at C3-C4, mild right neural foraminal compromise at C4-C5 and moderate right and mild left neural foraminal compromise at C5-C6 levels due to degenerative changes which are best appreciated on sagittal oblique series (1101 and 1001). The signal intensity and the caliber of the cord is within normal.Nonenhanced thoracic MRI:There is normal anatomical alignment and signal intensity of the vertebral column. There is multilevel mild to to moderate degenerative disc disease with loss of disc height.Mild multilevel chronic compressive deformities of the upper thoracic vertebrae without malalignment.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of central spinal stenosis at any level.There is moderate left foraminal compromise at T8-T9 and essentially unremarkable other neural foraminal.There is no detectable paraspinal soft tissue abnormalities.Nonenhanced lumbar MRI:Examination is suboptimal due to motion artifacts secondary to patient's back pain. Multiple MRI series were repeated to improve image quality without success.Unremarkable signal intensity and anatomical alignment of the vertebral column. Normal signal morphology and signal intensity of the conus and the cauda equina.No spinal stenosis at any level.There is an ill-defined focus of T1 hypointense, T2 hyperintense and T2 STIR mildly hyperintense of left articulating facet and adjacent soft tissues of L2-L3 which is new since prior exam.The finding results in moderate left neural foraminal compromise at this level. Asymmetric facet hypertrophy and or facet hypertrophy with post operative change should be considered as etiologies of this finding. Previously noted left lateral and far lateral disc protrusion at this level is no longer identified on these suboptimal images.No spinal stenosis or clinically significant neural foraminal compromise at any other level. Correlate with clinical findings and surgical history. Consider postcontrast imaging for better assessment of the neural foramina and possible postoperative epidural scarring.
1.MRI of cervical spine is unremarkable other than multilevel neural foraminal compromise as detailed per level above.2.MRI of thoracic spine demonstrate normal thoracic cord, no spinal stenosis, mild chronic compressive changes of the upper thoracic vertebra, moderate left neural foraminal compromise at T8-T9 level, and unremarkable paraspinal soft tissues.3.MRI of the lumbar spine demonstrate normal anatomic alignment and signal intensity of vertebral column without central spinal stenosis. Normal signal intensity and caliber of the cord and cauda equina. At L2-L3 there is an Ill-defined focus of T1 hypointense, T2 hypointense and mild T2 stir hyperintense of the left facet complex and adjacent soft tissues which results in moderate left neural foraminal compromise. This finding could represent asymmetric facet hypertrophic changes and or with associated postoperative changes. A previously noted left-sided disc protrusion at this level is no longer identified. No evidence of neural foraminal compromise at any other level.