Clinical question: Evaluate for abnormality. Cervical disk disease. Signs and symptoms: Bilateral upper arm pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative disease and unremarkable otherwise.C3 -- C4 demonstrate mild disk and facet disease. No central spinal stenosis however mild bilateral neural foraminal compromise is noted. C4 -- C5 demonstrate mild degenerative changes resulting in moderate right and mild left neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. There is a small left paramedian shallow disk protrusion with resultant partial effacement of the ventral subarachnoid space and mild flattening deformity of the cord. There is a faint focus of T2 hyperintensity of the cord posteriorly at this level which is best appreciated on sagittal T2 series 4 image 8 which is focus of edema or myelomalacia secondary to degenerative disease. There is moderate bilateral (right greater than left) neural foraminal compromise and mild central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height and T2 signal intensity, mild bilateral facet and ligamentum flavum degenerative changes. There is a prominent left lateral hypertrophic spur which significantly compromises the ventral subarachnoid space and mild flattening deformity of the ventral aspect of the cord without cord signal changes. Mild central spinal stenosis and mild left neural foraminal compromise is noted.There is also hypertrophic changes of the posterior longitudinal ligament extending from this level inferiorly through the entire uppermost visualized thoracic spine to T3 level.C7 -- T1 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. There is a small right paramedian shallow disk protrusion resulting in slight flattening deformity of the cord. Moderate left neural foraminal compromise and mild central spinal stenosis is present at this level.C7 -- T1 demonstrate advanced disk disease and loss of disk height, mild facet disease and ligamentum flavum hypertrophy is present. There is a shallow low T2 signal intensity finding in the left paramedian epidural space (axial T2 series 6 image 39) which may represent a tiny chronic disk fragment. This finding by subtle mass effect on the thecal sac. No evidence of central spinal stenosis or neural foraminal compromise. There is however a focus of T2/T2 stir hyperintensity in the left paramedian cord anteriorly with suggestion of decreased cord caliber on the left concerning for a focus of myelomalacia. This finding extends from approximately mid T1 level inferiorly to mid T2 level. No prior exams for comparison.Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical however there is mild straightening of lumbar lordosis.T12 -- L1 demonstrate degenerative changes however without spinal stenosis or neural foramina compromise.L1 -- L2 demonstrate a left paramedian and left lateral shallow broad base disk protrusion which results in mild mass effect on the thecal sac and mild left neural foramina compromise. There is also mild central spinal stenosis at this level.L2 -- L3 demonstrate moderate to advanced disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No neural foraminal compromise. Although degenerative changes demonstrate no significant mass effect on the thecal sac there is mild central spinal stenosis present at this level also. Possibility of underlying congenitally small canal/short pedicles cannot be entirely excluded.L3 -- L4 demonstrate mild disk disease and loss of disk height and extensive postoperative changes of the posterior elements and soft tissues. Although there is no detectable mass effect on the thecal sac at this level the overall caliber of the spinal canal is small. Moderate bilateral neural foraminal compromise (left greater than right) is also noted. L4 -- L5 also demonstrate moderate disk disease and loss of disk height, shallow diffuse bulging is, mild to moderate bilateral (right greater than left) ligamentum flavum hypertrophic changes and mild facet disease is present. There is mild central spinal stenosis and moderate to significant bilateral neural foraminal compromise.L5 -- S1 and the straight mild degenerative and hypertrophy changes of posterior elements and mild disk disease without loss of disk height. No central spinal stenosis or neural foraminal compromise.
1.Nonenhanced MRI of the cervical spine demonstrate degenerative changes extending from C5 -- C6 inferiorly to upper thoracic spine as detailed. Left paracentral small disk protrusion at C5 -- C6 with resultant flattening deformity of the cord on the left and faint focus of cord T2 hyperintensity as detailed. Osteophyte laterally at C6 -- C7 with resultant flattening deformity of the cord and the subtle T2 cord hyperintensity and mild central spinal stenosis. Right paramedian small disk protrusion at C7 -- T1 with subtle flattening deformity of the cord and associated cord T2 hyperintensity. T2 hyperintensity of the cord extending on the left lateral aspect of the cord from approximately T6 inferiorly to T2 level and with decreased cord caliber/myelomalacia. Multilevel neural foraminal compromise as detailed portable.2.Nonenhanced MRI of lumbar spine demonstrate a left paramedian and left lateral shallow disk protrusion at the L1 -- L2 with resultant mild central spinal stenosis and left neural foraminal compromise. Mild to moderate degenerative disk disease and hypertrophy changes of posterior elements and extensive postop changes of prior surgery at L3 -- L4 are also noted. Although there is no significant mass effect on the thecal sac there is generalized uniform smaller than expected caliber of thecal sac in the lumbar spine and with resultant central spinal stenosis at multiple levels as detailed per level above. Neural foraminal compromise as dictated per level above.