Clinical question: Rule out central canal stenosis or neural foraminal stenosis. Signs and symptoms: Hyperreflexia. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis however mild right neural foraminal compromise is noted.C3-C4 demonstrate mild degenerative disease and bilateral uncovertebral hypertrophy which results in moderate right and mild left neural foraminal compromise without central spinal stenosis.C4-C5 demonstrate mild disc disease, mild loss of disc height and mild bilateral facet degenerative changes. Findings results in moderate right and moderate to severe left neural foraminal compromise without central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is also a broad-based disc-osteophyte complex present at this level (larger on the left) with resultant effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is also significant bilateral neural foraminal compromise. There is also mild hypertrophic changes of posterior longitudinal ligament at C5 and C6 levels contributing the spinal stenosis. There is mild reversal of cervical lordosis at this level. The signal intensity of the cord remains within normal.C6-C7 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a shallow broad-based disc-osteophyte complex present at this level extending from midline to the left with resultant effacement of ventral subarachnoid space on the left, subtle flattening deformity of the cord and moderate central spinal stenosis. Significant bilateral (L>R) neural foraminal compromise is also detected.C7-T1 demonstrate mild degenerative changes without central spinal stenosis. There is however moderate to severe left and patent right neural foramen detected.The upper most visualized thoracic spine demonstrate no evidence of spinal stenosis or appreciable neural foraminal compromise.Nonenhanced lumbar MRI:There is normal anatomical alignment and unremarkable signal intensity of the vertebral column.Examination at T11-T12 through L2-L3 demonstrate mild degenerative changes without spinal stenosis or foraminal stenosis. L3-L4 demonstrate mild disc disease and loss of disc height, moderate bilateral facets hypertrophy and mild facet effusion. Mild ligamentum flavum hypertrophy is also noted. Although there is mass effect on the thecal sac by hypertrophic changes no convincing spinal or neural foraminal compromise or stenosis is present.L4-L5 demonstrate mild disc disease and moderate bilateral facet and ligamentum flavum hypertrophic changes. Mild right and patent left neural foraminal compromise and no central spinal stenosis.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum and advanced bilateral facet hypertrophic changes and including mild bilateral (R>L) facet effusion. No spinal stenosis, however significant (R>L) neural foraminal compromise is detected.
1.Degenerative changes at C5-C6 and C6-C7 levels with resultant moderate central spinal stenosis (worse at C5-C6) and bilateral neural foraminal compromise and mild reversal of cervical lordosis as detailed. Mild degenerative changes at other levels however without central spinal stenosis. Additional multilevel neural foraminal compromise as detailed per level.2.MRI of lumbar spine demonstrate mild degenerative disc disease and more severely degenerative and hypertrophic changes of facets and ligamentum flavum as detailed per level above. Findings are more noticeable in the lower lumbar spine in particular at L5-S1 level which results in significant bilateral neural foraminal compromise. There is however no central spinal stenosis at any level. Additional levels of neural foraminal compromise as detailed per level above. There is progression of degenerative changes since prior lumbar MRI exams from 2004.