Male, 67 years old, with end-stage renal disease and vague spinal pain. Evaluate for occult infection. Most sequences are degraded by motion artifact which limits the sensitivity of the examination. Given this caveat, the following observations are made.The articulation between the left lateral masses of C1 and C2 is severely degenerated with edema or fluid in the joint space and edema in the surrounding marrow. There is no evidence of significant pannus formation around the dens, and none of the other spinal articulations are affected similarly.Straightening of the cervical lordosis may be positional. Sagittal alignment is otherwise unremarkable. The remaining spinal elements are free of significant edema or marrow replacement. Image quality does not allow for accurate assessment of the spinal cord or epidural space. Minimal cervical disc degeneration is seen without significant spinal canal stenosis. The neural foramina are not well assessed, though no high-grade stenoses are suspected.
This examination is significantly limited by motion artifact. Nevertheless, severe bony degeneration and inflammation are seen centered on the articulation between the C1 and C2 lateral masses on the left. This joint appears to be involved in isolation. These findings may reflect accelerated degeneration related to a prior traumatic injury of this joint, or potentially a chronic infectious process. An inflammatory arthropathy would be less likely given the unilateral involvement of a single joint, though this is not completely excluded. Findings were discussed with Dr. Spiegel at 9:30 AM on 12/2/16.