Clinical question: Assess for spinal stenosis. Signs and symptoms: Myelopathy and unsteady gait. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.The signal intensity of vertebral column demonstrate changes consistent with degenerative disease.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes and a small centrally located disc protrusion resulting in effacement of ventral subarachnoid space and mild flattening deformity of the cord without central spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes resulting in mild central spinal stenosis, moderate right and mild left neural foraminal compromise.C5-C6 demonstrates moderate disc disease and loss of disc height and mild facet disease. Mild bilateral (L>R) neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum degenerative changes. Constellation of findings results in moderate to severe left and mild right neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate moderate disc disease and loss of disc height, mild ligamentum flavum and facet hypertrophic changes. There is resultant moderate to severe bilateral neural foraminal compromise and no central spinal stenosis. Upper most visualized thoracic spine demonstrate no spinal stenosis.
1.Degenerative changes of cervical spine results in multilevel bilateral neural foraminal compromise (some severe) as detailed per level above.2.Tiny central disc protrusion at C3-C4 results in mild central spinal stenosis.3.Mild central spinal stenosis is also noted at C4-C5 secondary to degenerative disease.4.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.