Loss of hand dexterity with worsening balance. Evaluate for spinal stenosis. There is moderate anterolisthesis of C3 on C4, measuring 6 mm. There is mild retrolisthesis of C4 on C5 and C5 on C6. The vertebral body heights are preserved. There is disc dessication with severe loss of disc height at C4-C5 through C6-C7. The vertebral bone marrow signal is benign. There is a 14 mm T2 hyperintense lesion in the subcutaneous fat of the back just right of midline (seen on the sagittal STIR) and a 19 mm T2 hyperintense lesion in the subcutaneous fat of the left posterior neck. The paravertebral soft tissues are otherwise unremarkable.C2-C3: Small posterior disc-osteophyte complex, bilateral facet degenerative changes and thickening of the ligamentum flavum, but no significant spinal canal or foraminal stenosis.C3-C4: Moderate anterolisthesis of C3 on C4 with pseudo disc bulge, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis, mild right and mild to moderate left foraminal stenosis. There is cord impingement at this level with subtle increased T2 signal.C4-C5: Posterior disc-osteophyte complex with central disc protrusion, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate bilateral foraminal stenosis. There is flattening of the cord ventrally.C5-C6: Posterior disc-osteophyte complex, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to mild to moderate spinal canal stenosis, moderate right and mild left foraminal stenosis. C6-C7: Posterior disc-osteophyte complex with central disc protrusion, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis, moderate right and mild left bilateral foraminal stenosis. C7-T1: No significant disc bulge, herniation, spinal canal or foraminal stenosis.
1. Advanced degenerative changes of the cervical spine with grade 2 anterolisthesis of C3 on C4, contributing to severe spinal canal stenosis and cord impingement with associated subtle increased T2 cord signal at this level likely representing myelomalacia. 2. Moderate spinal canal stenosis at C4-C5 and C5-C6 and to a lesser degree at C6-7. 3. Variable multilevel foraminal stenoses and facet arthropathy as detailed above.4. 14 mm lesion in the right paramidline subcutaneous fat of the back (seen on sagittal STIR) and a 19 mm lesion in the left posterior neck subcutaneous fat, which may represent sebaceous cysts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.