Syrinx of cervical and thoracic spine with adhesions. LP shunt. Worsening symptoms. Evaluate for changes. Examination is motion degraded. Again seen are are extensive postsurgical changes of suboccipital craniectomy and multiple cervical and thoracic laminectomies. Again seen is kyphotic attenuation of the cervical spine. Vertebral body heights are maintained. There are small disc protrusions at the C3-C4 to C5-C6 levels as well as a disc bulge at the C6-C7 level which are similar to prior and not associated with significant spinal canal stenosis. There is moderate to severe stenosis involving the right C3-C4 neural foramen and mild to moderate right and mild left neural foraminal stenosis at the C4-C5 level.Compared to 6/12/2014 there are areas of slight decrease in size of the cervical syrinx, which extends from the obex to the upper C6 level. For example at the mid C2 level syrinx measures 10 mm in the AP dimension previously 13 mm. At the right C4-C5 level, syrinx measures 3 to 4 mm in the AP dimension, previously 5 mm. There is significant volume loss involving the cervical and partially imaged thoracic cord as seen before with particular thinning at the lower cervical and thoracic level. The cord is posteriorly positioned along the posterior dural margin particularly at the cervicothoracic junction suspected to be related to adhesions. Position of the catheter within the syrinx from the C2-C4 level is similar to prior. A separate thoracic catheter is partially imaged. Thoracic syrinx which extends below the T2 level is seen only on the sagittal sequences.Diffuse calvarial thickening is partially imaged.
1. Note patient could not tolerate the full requested studies and only cervical spine MRI could be obtained. There is mild decrease in size of the cervical syrinx compared to 6/12/2014. Thoracic syrinx is partially imaged and not adequately assessed.2. Significant volume loss involving the cervical and thoracic cord as seen previously with particular flattening and posterior position of the upper thoracic cord which may be related to adhesions.