Lower extremity weakness and back pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis with mild anterolisthesis of C3 on C4 and to a lesser degree C4 on C5. Anterolisthesis of C3 on C4 measures up to 4 mm and is worse since prior CT when it measured approximately 1 to 2 mm. There is abnormal signal involving the cervical cord bilaterally at the C4 level. Advanced degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is severe spinal canal stenosis related to anterolisthesis, disc osteophyte complex, and ligamentum flavum thickening. There is flattening of the cord. Abnormal T2 signal seen in the cervical cord bilaterally at the C4 level. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: There is a disc osteophyte complex and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis and flattening of the cord. There is mild right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is moderate spinal canal stenosis and mild cord informed. There is moderate left and mild right neural foraminal stenosis.C6-7: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The right vertebral artery flow-void is diminutive with proximal occlusion better demonstrated on prior CT. Small chronic infarcts in the right cerebellar hemisphere noted. Paraspinous soft tissue structures appear within normal limits.
1. Advanced multilevel degenerative changes in the cervical spine worst at the C3-C4 level where there is severe spinal canal stenosis with cord deformity. There is abnormal T2 signal at this level which at least predominantly likely represents myelomalacia although some of this may represent edema. Comparison with prior CT from 3/11/2013 demonstrates evidence of interval worsening of degenerative disease including worsened anterolisthesis at this level. There is also significant but to a slightly lesser degree of spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Please see additional details above including multilevel neural foraminal stenosis.2. Diminutive right vertebral artery flow-void with proximal occlusion better demonstrated on prior CTA. Chronic right cerebellar infarct better seen on prior brain MRI.