65 years Male (DOB:12/7/1950)Reason: assess for osteo, infection, degeneration, or other etiologies of chronic neck/left arm arm pain History: neck pain/stiffness, left arm pain, hx of C3-c7 laminectomyPROVIDER/ATTENDING NAME: DAVID M. LIEBOVITZ DAVID M. LIEBOVITZ The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.There is marrow replacement within the right T3 superior facet and pedicle as well as the inferior facet of T2 and the T2 spinous process. There are associated destructive changes within the right T2-3 facet joint facet joint and encroachment of the exiting nerve roots within the left T2-3 neural foramenThe patient status post cervical spine surgery with multilevel laminectomies and posterior instrumentation from C3 through C7.
1.There is a destructive process involving the right superior facet and right pedicle of T3 associated with adjacent involvement of the T2 spinous process and inferior facet. This results in encroachment of the right-sided T2-3 exiting nerve roots. Differential considerations include arthritis/degeneration or infection.2.Patient is status post cervical spine surgery. Please refer to MRI of the cervical spine from 9/23/2016 for further comments.