Right-sided posterior scalp and neck pain There is T2/STIR hyperintensity and enhancement involving the right lateral mass of C1 as well as the right aspect of the dens extending posteriorly into the C2 right lateral mass. Edema and enhancement also noted within the intervening joint space.Alignment the craniocervical junction is maintained. Vertebral body heights and cervical spine are normal. There is mild anterolisthesis of C4 on C5 and minimal retrolisthesis of C5 on C6. No abnormal signal in the cervical cord. Degenerative changes include significant loss of disc height at the C5-6 level as well as multilevel facet arthropathy, relatively worse at the right C4-C5 and right C7-T1 levels. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Mild anterolisthesis and disc uncovering. Right-sided facet arthropathy. No significant spinal canal or neural foraminal stenosis. C5-6: Disc osteophyte complex, mild retrolisthesis, and ligamentum flavum thickening result in mild spinal canal narrowing. There is mild left and minimal right neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening result in minimal spinal canal narrowing. There is mild left and minimal right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina. Prominent right-sided facet arthropathy with surrounding enhancement.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Edema and enhancement involving the right lateral mass of C1 as well as the right aspect of the C2 vertebra. Finding is nonspecific and may be related to prior trauma, advanced degenerative changes, or inflammatory arthropathy. Suggest noncontrast CT cervical spine to better assess the osseous anatomy in this region.2. Multilevel degenerative changes in the cervical spine relatively worse at the C5-C6 and C6-C7 levels with up to mild spinal canal and mild neural foraminal stenosis as detailed above. No high-grade spinal canal or high-grade neural foraminal stenosis at any level.3. Facet arthropathy relatively worse at the C4-C5 and right C7-T1 levels. There is enhancement surrounding the right C7-T1 facet joint which may be on a degenerative versus inflammatory basis.