Clinical question: Hyperreflexia in upper extremities and lower extremities; rule out cervical pathology from last MRI in 2014. Signs and symptoms: Hyperreflexia. Nonenhanced cervical MRI:There is mild straightening of cervical lordosis however with maintained anatomic alignment.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate minimal degenerative disease and unremarkable otherwise.C4-C5 demonstrate mild degenerative disease and shallow broad-based bulging disc without spinal stenosis or neural foraminal compromise. Previously reported small central disc extrusion at this level is no longer identified. There is no evidence of a spinal stenosis or neural foraminal compromise. The signal intensity of the cord remains within normal and stable since prior exam.C5-C6 demonstrate moderate disc disease, mild bilateral symmetrical uncovertebral hypertrophy and mild ligamentum flavum hypertrophy. There is moderate bilateral neural foraminal compromise and without central spinal stenosis (best appreciated on oblique T2 series 8 and 9). No significant change since prior exam. Normal signal intensity of the cord.C6-C7 demonstrate moderate disc disease and loss of disc height, mild bilateral uncovertebral and ligamentum flavum hypertrophic changes without significant change since prior exam. No evidence of central spinal stenosis however moderate bilateral neural foraminal compromise is noted. This finding is best appreciated on oblique images on series 8 and 9. No cord signal abnormality.C7-T1 demonstrate mild disc disease and loss of disc height and moderate hypertrophic changes of the ligamentum flavum and mild facet disease. There is a left lateral and far lateral disc extrusion with resultant significant left neural foraminal compromise which is best appreciated on oblique series 9. There is suggestion of slight interval progression of this finding since prior study. However on prior exam there was a midline component of extruded disc that since prior exam has decreased in size and with resultant decrease in mass effect on the cord and better visualization of subarachnoid space. Right neural foraminal remains patent.Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column and with unremarkable signal intensity.The lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild disc desiccation and mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild to moderate disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc desiccation, mild bilateral facet and ligamentum flavum hypertrophy and no evidence of central spinal stenosis. There is a far lateral left-sided broad-based disc protrusion best appreciated on axial T2 series 15 on image 17 and axial T2 series 17 image 23.L4-L5 demonstrates mild disc desiccation, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise. There is however mild right lateral recess compromise.There is a right far lateral annular failure best appreciated on axial T2 series 15 image 11 and sagittal T2 series 12 images 4 and 5. A smaller far left lateral annular fissure is also noted and best appreciated on sagittal T2 series 12 image 12 and axial T2 series 15 image 11.
1.MRI of cervical spine demonstrate normal signal intensity and caliber of the cord and without evidence of myelitis. There is interval resolution of the tiny central disc extrusion at C4-C5 since prior study. There is interval decreased in the midline component of disc extrusion at C7-T1 since prior exam however with suggestion of interval increased size of the left lateral and far lateral component of extruded disc since prior exam with resultant significant left foraminal compromise. No evidence of central spinal stenosis. There are neural foraminal compromise at multiple levels as detailed per level above.2.Nonenhanced MRI of the lumbar spine demonstrate degenerative changes without evidence of central spinal stenosis at any level and no significant neural foraminal compromise. Mild right lateral recess compromise at L4-L5 secondary to degenerative disease. Far left lateral broad-based disc protrusion at L3-L4 and bilateral small annular fissures at L4-L5 levels as detailed above.