Clinical question: 64-year-old male with prostate cancer, rising PSA, history of cervical spine stenosis, evaluate for progression. Signs and symptoms: Prostate cancer, rising PSA. Pre- and post enhanced cervical MRI:Examination demonstrates no detectable marrow signal abnormality or enhancement to suggest metastatic disease to the vertebral column. Minimal enhancement of the articulating facets at C2-C3 on the left in a linear pattern is highly suggestive of enhancement secondary to degenerative disease (sagittal post enhanced series 1301 image 3). Examination is a status post anterior cervical fusion at C4, C5 and C6 levels.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and results in mild right neural foraminal compromise. Stable since prior study.C3-C4 demonstrate mild degenerative changes with resultant significant neural foraminal compromise (R>L) and no central spinal stenosis and without significant change since prior exam.C4-C5 demonstrate mild to moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements (right greater than left). There is significant right and moderate left neural foraminal compromise without central spinal stenosis. No significant change since prior exam.C5-C6 demonstrate postoperative changes of anterior fusion. There are significant bilateral neural foraminal (left greater than right) compromise and without central spinal stenosis. There is evidence of myelomalacia of the cord bilaterally at this level which were also present on prior exam.C6-C7 demonstrate extensive degenerative disc disease and postoperative changes of anterior fusion. Previously noted ventral epidural defect suggestive of disc protrusion and ligamentum flavum hypertrophy posteriorly are no longer identified (presumed to interval surgery) with resultant resolution of central spinal stenosis at this level. Small foci of myelomalacia of the cord at this level is also noted similar to prior exam.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Upper most visualized thoracic spine and thoracic cord is unremarkable.There is no detectable abnormal enhancement of the cord or the left meninges.
1.Examination demonstrate no evidence of metastatic disease.2.Interval resolution of previously noted central spinal stenosis at C6/C7 as detailed above.3.Postoperative changes of anterior fusion and no evidence of central spinal stenosis at any level.4.Extensive degenerative changes with resultant multilevel neural foraminal compromise (some significantly) as detailed per level above.5.Foci of myelomalacia of the cord without definitive interval change as detailed above.