Altered mental status, tremors, falls, abnormal upper extremity reflex response Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis. Alignment is otherwise grossly maintained. There is abnormal signal involving multiple vertebral bodies, most notably C4, C5, T1, and T2 levels, which is likely on a degenerative basis. There is significant disc height loss from the C3-C7 levels as well as at the T1-T2 level. There is abnormal T2 signal involving the cervical cord which extends from the upper C5 to upper C7 levels with suggestion of volume loss and likely related to myelomalacia. Additional details as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C4-5: Disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.C5-6: There is disc osteophyte complex and ligamentum flavum thickening contributing to moderate to severe spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. Cord signal abnormality with volume loss as mentioned above.C6-7: Disc osteophyte complex and ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. Cord signal abnormality as above.C7-T1: No significant compromise to the spinal canal. There is mild to moderate right and mild left neural foraminal stenosis. Bilateral facet arthropathy.T1-T2: There is disc bulge with effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
Advanced degenerative changes in the cervical spine with moderate to severe spinal canal stenosis at the C5-C6 level and moderate spinal canal stenosis at C4-C5 and C6-C7 levels. There is T2 signal abnormality in the cord from the C5 to C7 levels with volume loss, most compatible with myelomalacia. Multilevel neural foraminal stenosis as detailed above.