 Again seen are postsurgical changes of prior posterior fossa and upper cervical decompression for Chiari malformation with low-lying cerebellar tonsils again noted. Again seen is extensive T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged since 4/27/2009.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. There is also ligamentum flavum buckling narrowing the dorsal thecal sac which appears slightly worse than prior. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No central canal stenosis or neural foraminal compromise.
1.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.2.Multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5 which is minimally worse at the C4-C5 level compared to 4/27/2009. No high-grade spinal canal or neural foramina stenosis.3.Postoperative changes of suboccipital and upper cervical decompression for Chiari malformation. 