Diagnosis: Spinal stenosis, lumbar region CervicalgiaClinical question: eval for stenosis.Signs and Symptoms: Left > right hand numbness. Neck pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is heterogeneous marrow replacement throughout the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with mild narrowing of the neural foramina bilaterally. There are associated uncovertebral osteophytes at this level.At C4-5 there is no significant compromise to the spinal canal. There are small endplate and uncovertebral osteophytes present with narrowing of the neural foramina.At C5-6 there are endplate and uncovertebral osteophytes present associated with partial effacement of spinal fluid ventral to the spinal cord and encroachment of the neural foramina bilaterally more on the left than the right side where there is encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present bilaterally associated with disc material and mild narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is straightening of the normal cervical curvature. There is diffuse marrow replacement throughout the area vertebral musculatureAt L5-S1 there is loss of disc space height, disc desiccation and endplate reactive changes associated with a diffuse disc bulge. Endplate reactive changes are high signal on T1 indicating that they are chronic. There is right-sided facet hypertrophy more than left-sided facet hypertrophy at this level. There is narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots within the neural foramen. There is a left far lateral disc protrusion present at this level which abuts and displaces the left-sided exiting nerve roots after they exit the neural foramina.At L4-5 there is loss of disc space height, disc desiccation and endplate reactive changes associated with a diffuse disc bulge. Endplate reactive changes are high signal on T1 indicating that they are chronic. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and a mild disc bulge at this level. There is mild ligamentum flavum and facet hypertrophy at this level. There is crowding of the nerve roots within the thecal sac at this level. This crowding in part is related to epidural lipomatosis.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. There is some crowding of nerve roots within the thecal sac at this disc space level. This crowding in part is related to epidural lipomatosisAt L1-2 there is no significant compromise to spinal canal or neural foramina.At T11-T12 on sagittal imaging there is a disc bulge present which mildly effaces spinal fluid ventral to the spinal cord.
1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 where there is encroachment of the left-sided exiting nerve roots. There are mild degrees of encroachment of exiting nerve roots at C4-5 and C5-6 and on the right-sided C5-6.2.Heterogeneous marrow replacement in the spine is a nonspecific finding. It could be related to anemia, lymphoproliferative sarcoma myeloproliferative disorder or chronic disease. It is nonspecific.3.There are multilevel degenerative changes present in the lumbar spine. There are some superimposed epidural lipomatosis. This leads to narrowing of the thecal sac with spinal stenosis at L3-4 and L2-3.4.There is encroachment of the exiting nerve roots within the right neural foramen at L5-S1 related to disc disease.5.There is some displacement of the left-sided exiting nerve roots at L5-S1 after exiting the neural foramen related to a left far lateral disc protrusion.