Male, 62 years old, with left lower extremity weakness and bilateral lower extremity numbness. Cervical:Evidence of instrumented anterior fusion is seen at C5 and C6. There is a grade 1 anterolisthesis of C5 relative to C6. Elsewhere, the cervical lordosis is straightened.There may be some degree of osseous fusion of the C3 and C4 vertebral bodies as there is no clearly recognizable disc space. The C3 and C4 vertebral bodies demonstrate patchy fatty replacement which may be degenerative in nature. Elsewhere, the visualized marrow signal is within normal limits.Due to the spondylolisthesis of C5 relative to C6, there is narrowing of the spinal canal at this level with mild associated impingement and kinking of the spinal cord. There may be slightly increased T2 signal within the cord at this level as well. Elsewhere, cord morphology and signal characteristics are within normal limits.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild facet hypertrophy. Fusion across the disc space without significant disc osteophyte formation. No spinal canal stenosis. Minimal if any left foraminal narrowing. C4-5: Right paracentral and foraminal disc osteophyte formation. The right ventral thecal sac and lateral recess are effaced. Severe right and moderate left foraminal narrowing. C5-6: Spondylolisthesis as above with significant associated spinal canal narrowing and slight kinking of the spinal cord. Moderate bilateral foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. The thyroid gland is partially visualized but appears to be nodular bilaterally. Patchy fluid signal is seen within the mastoid air cells.Thoracic:Abnormal T2 signal is again seen within the T9-10 disc space and adjacent marrow. The endplates are severely irregular. Extension of this process is seen into the ventral epidural space with cord impingement and severe spinal canal stenosis. Extension is also seen into the anterior paraspinal soft tissues with adjacent edema. These findings overall appear similar to the prior examination.Relatively mild abnormal T2 signal within the T8-9 and T7-8 intervertebral discs with matching mild abnormal signal in the adjacent vertebral body marrow is seen. These findings are nonspecific and could be either degenerative or infectious/inflammatory in nature. Again, findings are similar to prior. Marrow signal abnormality is also seen within the T11 and T12 vertebral bodies, perhaps in association with small Schmorl's nodes, similar to prior.The spinal cord shows normal signal characteristics throughout.Spinal alignment is within normal limits otherwise. Except where endplate irregularities are seen, the vertebral bodies demonstrate preserved height.Mild edema of the posterior paraspinal musculature is seen on the right in the lower thoracic region.Lumbar:Marrow signal characteristics are extremely heterogeneous with patchy areas of T1/T2 hyperintensity likely representing degenerative endplate signal change. There are multiple scattered Schmorl's node deformities similar to prior. Vertebral body height is nevertheless grossly maintained. Alignment is anatomic. No significant change is noted from the prior examination.The visualized distal spinal cord and conus show normal signal intensity and morphology. No epidural abnormalities are suspected.L1-2: No significant spinal canal or foraminal stenosis.L2-3: No significant spinal canal or foraminal stenosis.L3-4: No significant spinal canal or foraminal stenosis. L4-5: Marked facet hypertrophy with ligamentum flavum thickening. Right-sided disc bulge contributing to a moderate to severe generalized spinal canal stenosis with particular effacement of the right lateral recess, and a severe right foraminal narrowing. The left neural foramen is mildly narrowed. L5-S1: Mild facet hypertrophy with ligamentum flavum thickening. Mild disc bulging asymmetric to the right. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. The kidneys are small and cystic compatible with chronic renal failure.
1.Evidence of anterior instrumented fusion of C5 and C6. Spondylolisthesis at this level results in a significant spinal canal narrowing and impingement/kinking of the spinal cord. Findings are similar to prior. Significant foraminal narrowing is also evident bilaterally at C4-5 and C5-6. There has been no significant interval change in these findings.2.Findings are again seen highly concerning for discitis osteomyelitis centered at T9-10. There is ventral epidural extension of this process which causes a severe spinal canal stenosis and cord impingement but without frank cord signal abnormality. Relatively mild disc and endplate signal change at T7, T8, T11 and T12 is of uncertain significance and could be degenerative or inflammatory/infectious. Findings have not significantly changed.3.Extensive endplate degeneration through the lumbar spine. Disc degeneration is also seen, most severely affecting the L4-5 level where there is a moderate to severe spinal canal stenosis, particularly affecting the right lateral recess, and a severe right foraminal narrowing. Findings have not significantly changed.