Diagnosis: Ankylosing spondylitis of unspecified sites in spineClinical question: myelopathySigns and Symptoms: pain and decreased motion Cervical spine:The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal. There is some fusion of the facet joints at this level as well as some facet hypertrophy.At C3-4 there is no significant compromise to the spinal canal . There is bilateral facet hypertrophy at this level. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal . Findings suggest some fusion at the facet joints with facet hypertrophy. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C5-6 there is some loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes. There is bilateral facet hypertrophy at this level. There is a diffuse disc bulge at this level. There is hypertrophy of the ligamentum flavum at this level. There is mild posterior subluxation of a C5 on C6. There is effacement of spinal fluid ventral and posterior to the spinal cord with minimal flattening of the spinal cord. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes as well as some mild facet hypertrophy. There is narrowing of the neural foramina and encroachment of the exiting nerve roots bilaterally at this level. The encroachment of exiting nerve roots is worse on the left compared to the right side. Also some encroachment of the nerve roots at the left lateral recess at this level. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentum flavum hypertrophy at this level.The right vertebral artery flow-void is not identified and in fact there is T2 signal hyperintensity within the right vertebral artery.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. Marrow signal is of high signal on T1 indicating fatty replacement. On the prior exam marrow signal is more heterogeneous. There is loss of vertebral body height due to inferior endplate compression at L5 and due to superior endplate compression at L4, L3, L2 and L1 as well as T12.The anterior longitudinal ligament does appear thick. This is not appear to be any convincing evidence for enthesitis, though contrast enhanced imaging was not performed.At L5-S1 there is no significant compromise to spinal canal. There is some facet hypertrophy at this level with narrowing of the neural foramina. There is mild disc bulge at this level. The fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is moderate bilateral facet hypertrophy associated with a diffuse disc bulge and some epidural lipomatosis. There is narrowing of the thecal sac with effacement of the spinal fluid surrounding the nerve roots. There is narrowing of the neural foramina with effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally. Overall there is a moderate to severe degree of spinal stenosis at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. The fat surrounding the exiting nerve roots within the neural foramina is mildly effaced at this level. There is mild to moderate facet hypertrophy at this level. The fat at the lateral recesses is not effaced at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cystic lesions in the kidneys and the kidneys appear to be relatively small.
1.There is fusion across the facet joints in the upper cervical spine. There is a CT of the maxillofacial bones which demonstrate cyst in greater detail and also demonstrates some anterior osseous bridging at the C1-2 and C2-3. A CT of the cervical spine would be of further benefit in assessing extent of facet joint and vertebral ankylosis.2.There are multilevel degenerative changes in the cervical spine with findings compatible with a moderate degree of spinal stenosis with mild subluxation at C5-6 and neural foraminal encroachment of exiting nerve roots bilaterally at C3-4, C4-5, C5-6 and C6-7.3.Occlusion of the right vertebral artery.4.There are multilevel degenerative changes present in the lumbar spine with moderate to severe spinal stenosis at L4-5 where there is also encroachment of the exiting nerve roots within the neural foramina. This was also present on 11/7/2014 and has not changed.5.There is multilevel loss of vertebral body height in the lumbar spine.6.There is no convincing evidence for any active Romanus lesion. Please note that examination the sacroiliac joints was not performed7.Multiple cystic type lesions are present in the kidneys which have also been present on prior abdomen CTs8.In general the marrow signal in the lumbar spine appears somewhat more hyperintense. This raises the possibility of prior radiation treatment. Please correlate with patient's clinical history.