Male, 75 years old, with right upper extremity weakness. Assess for cord compression. Cord compression exam:A scoliotic curvature of the thoracic and lumbar spine is noted. Sagittal alignment of the spine is reasonably anatomic.Vertebral body heights are preserved allowing for mild right lateral wedging of L2 and L3 which is a stable finding likely related to scoliosis.Marrow signal intensity is diffusely and markedly heterogeneous similar to prior. No definite worrisome marrow replacement is seen. Mild edema is evident within the marrow of L2 and L3.Multilevel cervical spondylosis is demonstrated in the cervical spine resulting in significant canal stenoses, but are better assessed in the dedicated exam dictated below.Multilevel thoracic spondylosis is evident without significant spinal canal narrowing. Scattered mild-to-moderate foraminal narrowing is evident.Multilevel spondylosis and posterior element hypertrophy affect the lumbar spine, resulting in mild to moderate canal stenoses, appearing similar to prior. Prominence of the epidural fat also contributes. Scattered foraminal narrowing is also seen most severely affecting the L4-5 level.Although incompletely visualized on this limited study, fat signal intensity is evident along the cauda equina and/or filum terminale suggestive of fatty infiltration of the filum terminale also appearing similar to prior. Findings suggestive of prior surgery are seen in the lumbar region, though the nature of the surgery is uncertain and this appearance may also be due to severe degeneration.Dedicated C-spine exam:Spinal alignment is anatomic allowing for a mild likely positional straightening of the cervical adenosis. Vertebral body heights are grossly preserved except for areas of degenerative endplate irregularity. Bone marrow signal intensity is diffusely heterogeneous but free of worrisome marrow replacement.Severe disc degeneration is evident most conspicuously affecting the C3-4 through C6-7 levels with loss of disc height, bulky anterior osteophyte formation, and posterior disc osteophyte formation. On comparison with a prior examination from 2011, no significant interval change is seen in these findings. Level specific details are as follows:C2-3: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C3-4: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Severe generalized spinal canal stenosis with cord impingement. Mild ill-defined cord T2 hyperintensity is suspected. Mild to moderate bilateral foraminal narrowing.C4-5: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Severe spinal canal stenosis with cord impingement. Mild ill-defined cord T2 hyperintensity is suspected. Moderate bilateral foraminal narrowing. C5-6: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No cord impingement. Severe left and moderate right foraminal narrowing.C6-7: Uncovertebral hypertrophy and posterior disc-osteophyte complex formation. Moderate spinal canal narrowing. No cord impingement. Severe left and moderate right foraminal narrowing.C7-T1: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing.
1.Severe spinal canal stenosis in the cervical region affecting C3-4 and C4-5 predominantly. The stenoses are degenerative in nature and chronic showing no significant interval change when compared to an exam from 2011. There may be mild abnormal cord signal at the levels of greatest stenosis which could reflect a combination of edema and myelomalacia.2.Degenerative disease is evident elsewhere in the spine resulting in mild to moderate scattered canal stenoses. A significant scoliotic deformity affects the thoracic and lumbar spine. Findings are seen in the lumbar region suggestive of fatty infiltration of the filum terminale, similar to those seen on prior studies.