Status post C3-C7 laminoplasty on October 2, 2015. Persistent MRSA bacteremia. New onset right deltoid weakness. Patient was imaged in a neck collar and unable to lie straight in the scanner. There are changes related to previous C3-C7 laminoplasty with bone graft struts at C4 and C6. The osseous findings are better assessed on the most recent CT scan from December 6, 2015. There is fluid within the paraspinal soft tissues along the posterior midline incision with associated extensive surrounding inflammatory change. Axially, the fluid is the largest C4-C5 level where it measures 2.2 cm x 1.8 cm. Craniocaudally, it measures 4.8 cm. Numerous foci of susceptibility artifact within the fluid may relate to the presence of microscopic metallic fragments or less likely gas. Given the timing of the laminoplasty, the inflammatory change is more extensive than expected. This above inflammatory change is associated with abnormal increased T2 signal along the C3-C4 and C4-C5 facets bilaterally. This is new compared to the preoperative MRI. This correlates with erosion involving the left C3-C4 facet which had progressed between the CT scans from October 3, 2015 and December 6, 2015. While this facet abnormality might be partly reactive from the adjacent soft tissue inflammation in the setting of pre-existing degenerative facet disease, the possibility of osteomyelitis should also be considered.There is abnormally increased T2 signal within the C3-C4 disc which is new since the previous preoperative MRI. Associated irregularity focally involving the endplates along the right posterior-lateral aspect of the disc was present on the previous MRI and probably reflect degenerative change. This increased disc T2 signal extends into the epidural space and reflect fluid within the pre-existing central and right posterior-lateral extruded disc. However, compared to the preoperative MRI, this epidural soft tissue thickening has minimally increased if at all from prior. This results in no significant mass effect on the spinal cord given the recent laminoplasty. There is no significant epidural collection at any other level. There is no definite cord signal abnormality. There is edema and fluid in the prevertebral space extending from C5-C6 level cranially to the level of the skull base with abnormal signal involving the left longus coli muscle. This is increased compared to the most recent CT scan from December 2015. The thickness of the prevertebral soft tissues at C3 is 16 mm now, compared to 7 mm on the CT scan from December 2015.The multilevel spinal canal narrowing on the preoperative MRI has improved at C3-C4 and resolved at the other levels, especially C6-C7. Foraminal stenoses are not significantly change since the preoperative MRI.Imaging through the upper thorax, there is dependent signal abnormality which may reflect small pleural effusions and atelectasis. As minimal fluid in the mastoid air cells.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Improved, now mild, canal stenosis following laminoplasty. There is a right paracentral disc extrusion which is unchanged to very minimally increased compared to the previous MRI examination. There is unchanged mild left neuroforaminal stenosis.C4-C5: There is no spinal canal stenosis. There is mild bilateral foraminal stenoses.C5-C6: There is a disc-osteophyte complex but no spinal canal stenosis. There is moderate left and mild right foraminal stenosis.C6-C7: Disc-osteophyte complex asymmetric to the right. These changes, however, result in no significant spinal canal stenosis given the recent decompression through laminoplasty. There is moderate left and mild right foraminal stenosis, which are unchanged.C7-T1: There is no spinal canal or foraminal stenosis.
1.The study was performed without intravenous contrast and is of suboptimal quality.2.The spinal canal has been decompressed following laminoplasty. There is no spinal cord signal abnormality. There is no definite epidural abscess but the study was performed without intravenous contrast.3.Fluid in the paraspinal soft tissues along the posterior midline incision along with extensive surrounding soft tissue inflammatory change is more than expected at this point postoperatively.4.Progressive prevertebral edema, especially on the left, and retropharyngeal effusion are also present. These findings could be infectious in nature.5.Increased T2 signal in the C3-C4 disc with minimal if any increase in the associated ventral epidural thickening, which is at least partly related to disc extrusion and is nonspecific in this postoperative setting. It may relate to degenerative disease or early/treated discitis.6.Abnormal T2 signal at the C3-C4 and C4-C5 facets with associated progressive erosions at the left C3-C4 facet may be related to a combination of degenerative disease and reactive change caused by the adjacent soft tissue inflammation. However, osteomyelitis should also be considered.7.Findings in the included upper chest (pleural effusions and atelectasis) are better assessed on the recent CT scan from December 11, 2015. 8.Also, please refer to the previous CT scan from December 6, 2015 for an assessment of fine osseous detail.