Clinical question: Evaluate for worsening of cervical spinal stenosis, impingement upon the canal. Signs and symptoms: Neck pain, left hand first 3 digits with decreased strength. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of the vertebral column however with reversal of cervical lordosis likely secondary to extensive degenerative disease.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild central spinal stenosis without neural foraminal compromise.C3-C4 demonstrate moderate disc disease and loss of disc height, there is a broad-based central and left lateral disc protrusion which results in mass effect, flattening and posterior displacement of the cord. There is resultant moderate central spinal stenosis, significant bilateral neural foraminal compromise (left greater than right). There is no detectable cord signal abnormality.C4-C5 demonstrate moderate disc disease and loss of disc height with mild hypertrophic changes of posterior elements. Degenerative changes results in flattening and posterior displacement of the cord and with resultant moderate central spinal stenosis and significant bilateral (right greater than left) neural foraminal compromise.C5-C6 demonstrates moderate disc disease and loss of disc height, mild (left greater than right) facet hypertrophic changes. There is shallow broad-based bulging disc which results in flattening and posterior displacement of the cord and resultant moderate central spinal stenosis. Significant left and moderate right neural foraminal compromise is also present.C6-C7 demonstrate moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements. Changes at this level results in mild to moderate central spinal stenosis and significant left neural foraminal compromise.C7-T1 through T2-T4 levels are unremarkable.
1.Extensive degenerative changes of the disc and minimally of the posterior elements in the cervical spine as detailed.2.There is resultant multilevel mass effect and posterior displacement of the cord and moderate central spinal stenosis at C3-C4, C4-C5 and C5-C6 levels without detectable cord signal abnormality. A left lateral broad-based disc protrusion at C3-C4 contributes to mass effect on the cord and central spinal stenosis.3.There is mild reversal of cervical lordosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above.4.No detectable cord signal abnormality.5.Unremarkable upper most visualized thoracic spine to T3-T4 level.