Scleroderma, right head tilt, developed right-sided torticollis over a few days in November. Craniovertebral junction appears grossly within normal limits, with head tilt better seen on recent radiographs. There is reversal of cervical lordosis with kyphotic angulation centered at the C5 level. There is loss of height involving the C6 vertebral body and to a milder degree involving the C4 and C5 levels which appear minimally worse since 10/8/2015. There is diffuse osteopenia which is better assessed on recent radiographs. There is anterolisthesis of C3 on C4 which appears minimally worse since prior. There is mild retrolisthesis of C4 on C5 which is similar to prior. There is minimal C2-C3 anterolisthesis similar to prior.Compared to 10/8/2015 there has been interval increase in fluid within the C3-C4 disc space. There is also interval development of bone marrow edema involving the C3, C4, C5, and C6 vertebral bodies. Edema in the interspinous region is noted at the C5-C6 level and to a lesser degree more superiorly in the posterior paraspinous soft tissues. There is also small amount of prevertebral fluid which is new since prior. There is fluid distention involving the left C2-C3 facet joint which was present previously.No abnormal signal within the cervical cord is definitively appreciated. There is deformity in the cord contour related to the vertebral malalignment, which appears worse and in part related to differences in position.Degenerative changes in the cervical spine including disc osteophyte complexes and significantly diminished disc space at the C3-C4, C4-C5, C5-C6, and C6-C7 levels, worst at the C5-C6 and C6-C7 levels. Individual levels as described below:C2-3: Small central disc protrusion and ligamentum flavum laxity without significant spinal canal or neural foraminal stenosis.C3-4: Small central disc protrusion and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and no significant right neural foraminal stenosis. There is prominent facet arthropathy on the left.C4-5: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and left-sided facet arthropathy. C5-6: There is disc osteophyte complex with moderate spinal canal stenosis. There is mild left and no significant right neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with minimal spinal canal stenosis. There is uncovertebral hypertrophy with mild bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
Advanced multilevel degenerative changes in the cervical spine are again seen including moderate degree of spinal canal stenosis at C3-C4, C4-C5, and C5-C6 levels similar to prior 10/8/2015. There is however interval increase in fluid involving the C3-C4 disc space with suggestion of minimal worsening of anterolisthesis at this level. There is also more pronounced increase in bone marrow edema involving the C3 to C6 vertebral bodies. There is moderate loss of height involving the C6 vertebral body and to a milder degree involving the C4 and C5 levels which appears mildly worse; osteopenia is more evident on radiographs. There is also interval increase in edema at the interspinous level at the C5-C6 level and to a lesser degree more superiorly in the posterior paraspinous soft tissues. There is also development of mild prevertebral fluid collection.Overall the new findings may all be related to trauma if there is history, including interspinous ligamentous injury at the C5-C6 level. The increased fluid in the C3-C4 disc space is likely related to instability although infection cannot be entirely excluded.