Upper extremity weakness, left hand weakness. Cervical stenosis, evaluate for preoperative planning for decompression. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained, aside from straightening, which may be in part positional. Bone marrow signal is benign.There is flattening of the cord with significant bilateral parenchymal volume loss and T2 hyperintensity bilaterally at the C5-C6 level consistent with myelomalacia. There is prominent low T2 signal dorsal to the C5 and C6 vertebral bodies compatible with ossification of the posterior longitudinal ligament, better assessed on CT.The upper and mid cervical spinal canal appears developmentally narrow with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small dorsal annular fissure and protrusion. There is mild spinal canal stenosis. Neural foramina are patent.C5-6: Prominent disc osteophyte complex slightly eccentric to the left which is associated with flattening of the cord, volume loss, and bilateral T2 cord signal abnormality. There is moderate to severe spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C6-7: Right paracentral disc osteophyte complex which effaces the right ventral aspect of the thecal sac. No significant spinal canal stenosis overall at this level. Neural foramina are patent.C7-T1: Small left paracentral disc osteophyte complex without significant spinal canal stenosis. There is minimal left neural foraminal narrowing. Right neural foramen is patent.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear grossly within normal limits. Partially imaged left mastoid air cell opacification.
Moderate to severe spinal canal stenosis at the C5-C6 level related to disc osteophyte complex and ossification of the posterior longitudinal ligament. There is flattening and volume loss of the cord at this level, as well as prominent bilateral cord signal abnormality; findings are most consistent with myelomalacia from chronic compression. There is also moderate left and mild right neural foraminal stenosis at this level. Mild degenerative changes at additional levels as above.