Male, 64 years old, with upper extremity weakness, fasciculations and atrophy, with history of lumbar foraminal stenosis with weakness and hyperreflexia. Also with asymmetric pupils. There is a reversal of the normal cervical lordosis centered at C3. In addition, there is a trace anterolisthesis of C2 relative three, and a trace retrolisthesis of C5 relative to C6, all of which findings are likely degenerative in nature.Edematous endplate signal alteration is seen along the C3-4 disc, likely degenerative. Elsewhere the marrow signal intensity is heterogeneous but without frankly worrisome features. Facet arthropathy with osseous and paraspinal edema is noted at C7-T1 bilaterally.The spinal cord demonstrates normal signal characteristics throughout. Morphology is unremarkable except as discussed by level below. Lobular soft tissue is evident filling the left C7-T1 neural foramen and projecting slightly into the spinal canal with indentation of the adjacent dura. This nodule measures up to 12 x 7 mm. The right vertebral artery flow void is not clearly visualized which may represent slow flow, stenosis or occlusion. The intervertebral discs demonstrate loss of disc height and T2 signal, particularly from C3 through C6. Additional level specific findings are as follows:C2-3: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C4-5: Mild facet and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C5-6: Mild facet hypertrophy. Disc osteophyte formation. Effacement of ventral thecal sac with slight flattening of the ventral cord but no cord signal abnormality. Moderate left and mild right foraminal narrowing. C6-7: Uncovertebral hypertrophy. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C7-T1: Advanced facet arthropathy. Posterior disc-osteophyte complex formation with a small superiorly directed disc herniation. Left foraminal soft tissue nodule as discussed above. Ligamentum flavum thickening. Findings contribute to produce a mild to moderate generalized spinal canal narrowing particularly in the transverse dimension. Mild right foraminal narrowing. Moderate to severe left foraminal narrowing.
1. Nodular soft tissue is evident within the left neural foramen at C7-T1. The differential for this finding would include a small tumor such as a schwannoma, or perhaps an extruded disc or inflammatory tissue related to the adjacent severe facet arthropathy. Further evaluation with contrast-enhanced MRI images is suggested as this would better assess for the possibility of a tumor.2. Multilevel degenerative findings are seen affecting with the discs and posterior elements. Spinal canal stenosis are seen at C5-6 and at C7-T1. Advanced facet arthropathy is also noted at C7-T1.