Clinical question: The stenosis? Signs and symptoms: 61-year-old female with right hand numbness, previous fusion. Nonenhanced cervical MRI:Examination demonstrates extensive postoperative changes of anterior approach spinal fusion of C3, C4 and C5 levels. Fusion includes placement of an anterior metallic plate and fixating screws in the vertebral bodies of C3, C4 and C5. There is normal anatomical alignment of vertebral column. There is also fusion of vertebral bodies of C6 and C7 without evidence of surgical intervention.Foramen magnum is unremarkable.C2-C3 demonstrate mild disc disease, shallow disc-osteophyte complex, moderate left and mild right facet and moderate bilateral ligamentum flavum hypertrophic changes. Constellation of changes results in flattening and posterior displacement of the cord with complete effacement of subarachnoid space and moderate central spinal stenosis. There is also significant left and moderate right neural foraminal compromise. No detectable signal abnormality of the cord.C3-C4 demonstrate post operative changes with mild central spinal stenosis. There is moderate right and mild left neural foraminal compromise.C4-C5 demonstrate postoperative changes without central spinal stenosis. Moderate left and patent right neural foraminal.L5-C6 demonstrate no spinal stenosis however moderate left neural foraminal compromise and unremarkable left right neural foraminal.C6/C7 demonstrate no spinal stenosis or neural foraminal compromise.C7-T1 demonstrate mild degenerative changes and asymmetric mild left facet and ligamentum flavum hypertrophic changes resulting gain mild left neural foraminal compromise and no central spinal stenosis.There is no detectable signal abnormality of the cord.
1.Postoperative changes of anterior approach spinal fusion from C3 through C5 with only residual mild central spinal stenosis at C3-C4.2.Degenerative changes at C2-C3 with resultant moderate central spinal stenosis as detailed.3.No spinal stenosis at any other level.4.There are multilevel neural foraminal compromise of varying degrees as detailed per level above.5.No detectable myelopathy.6.Incidental note is made of a focus of T2 hyperintensity (sagittal T2 series) in the dorsal aspect of pons which is nonspecific however could represent a focus of lacunar infarct of indeterminate age.