Headaches, CT shows tightening at the foramen magnum As seen on recent CT study there is prominent retroodontoid soft tissue thickening without erosion. There is a cystic component involving the posterior and superior aspect of the lesion. There is mass effect with deformity and kinking at the cervicomedullary junction. No abnormal parenchymal signal abnormality is appreciated. There is also effacement of the dorsal thecal sac at the level of the posterior C1 arch which narrows the spinal canal which contributes to the moderate spinal canal stenosis at the C1-C2 level.Vertebral body heights in the cervical spine are maintained. There is borderline widening of the anterior atlantoaxial joint with predental space measuring 2.5 mm, slightly more prominent than on recent cervical spine study. Radiographs may be considered to assess for instability at this level.Vertebral body heights in the cervical spine are normal. No cord signal abnormality. There is loss of cervical lordosis with mild retrolisthesis of C5 on C6. Again seen are multilevel degenerative changes with severe loss of disc space at the C5-C6 level and to a lesser degree C6-C7 and T1-T2 level. Individual levels as below:C2-3: No significant spinal canal stenosis. There is bilateral facet arthropathy, right worse than left, with mild to moderate right and mild left left neural foraminal stenosis. C3-4: There is right paracentral disc osteophyte complex, uncovertebral hypertrophy, and right worse than left facet arthropathy. There is no significant spinal canal narrowing. There is moderate to severe right and mild to moderate left neural foraminal stenosis. C4-5: There is disc osteophyte complex, ossification along the posterior longitudinal ligament, and right worse than left facet arthropathy. There is mild to moderate spinal canal narrowing. There is also moderate bilateral neural foraminal stenosis. Vacuum phenomena at the disc space.C5-6: Left paracentral osteophyte complex, mild ossification of the posterior longitudinal ligament, and bilateral uncovertebral hypertrophy, which results in moderate to severe spinal canal stenosis involving the left aspect of the spinal canal. There is severe left and moderate to severe right neural foraminal stenosis. There is severe loss of disc height at this level with vacuum phenomena.C6-7: There is disc osteophyte complex and mild ossification of the posterior longitudinal ligament. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal stenosis. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. There are multiple cystic and solid nodules involving the bilateral thyroid lobes which were better assessed on prior thyroid ultrasound. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Prominent retroodontoid soft tissue is again seen which is likely on a degenerative basis. There is a cystic component along its posterior-superior aspect, which is favored to represent a synovial cyst. There is associated mass effect with contour deformity and impression on the ventral cervicomedullary junction. No associated parenchymal signal abnormality. 2. There is borderline widening of the atlantoaxial distance. Consider dynamic radiographs to assess for atlantoaxial instability. 3. Multilevel degenerative changes with moderate to severe spinal canal stenosis involving the left aspect of the thecal sac at the C5-C6 level. There is also significant neural foraminal stenosis at multiple levels, as detailed above.