Female, 68 years old, with bilateral upper extremity pain and difficulty ambulating. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Extensive degenerative endplate marrow signal change is seen, however no evidence of significant marrow edema is detected.T2 hyperintensity is seen within the spinal cord at the C4-5 level in the context of spinal canal stenosis, as discussed below. Elsewhere, the cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.The spinal canal is congenitally slender. Additional superimposed degenerative findings are as follows:C2-3: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation with mild spinal canal narrowing and very slight deformation of the spinal cord. Mild left foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation with moderate to severe spinal canal narrowing and flattening of the spinal cord with spinal cord signal abnormality. Mild right and moderate left foraminal narrowing. C5-6: Loss of disc height without significant disc osteophyte formation or spinal canal stenosis. No significant foraminal narrowing. C6-7: Loss of disc height without significant posterior disc-osteophyte complex formation. No spinal canal stenosis. No significant foraminal narrowing. C7-T1: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing.
Multilevel disc degeneration is evident. C4-5 is the most severely affected level where a disc osteophyte complex along with a congenitally slender spinal canal produces moderate to severe canal stenosis, cord deformation and abnormal cord signal which may represent either edema or myelomalacia.