Reason: Left triceps hyperreflexia, c/f cervical myelopathy History: LUE hyperreflexia in patient with infectious endocarditis and L4 osteo and septic emboli in the brain - history of cervical neck injection for pain 1 month ago Cervical: There is moderate degree of edema involving the C6 and C7 vertebral bodies with mild extension into the prevertebral region. There is severe loss of intervening C6-C7 disc space. Mild erosive changes are noted at the C6 and C7 endplates. There is mild enhancement involving the prevertebral and right paravertebral soft tissues including the right neural foramen. No discrete fluid collection or abscess is appreciated.Vertebral body heights are normal. Bone marrow signal is benign. No focal suspicious osseous lesions are evident. There are multilevel degenerative changes with levocurvature of the cervical spine. No significant spondylolisthesis. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine 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: No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex including uncovertebral hypertrophy and bilateral facet arthropathy. There is mild spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis. C6-7: There is no significant spinal canal stenosis. There is bilateral uncovertebral hypertrophy contributing to mild to moderate 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. Bilateral pleural effusions are again seen. There is a T2 hyperintense nodule measuring 11 x 21 mm in the right thyroid lobe.Thoracic: The thoracic spine is in normal alignment aside from minimal anterolisthesis of T2 on T3. The vertebral body heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Mild multilevel degenerative changes are present including a central disc extrusion at the T7-T8 level which contacts the ventral cord without significant spinal canal stenosis overall. There is minimal cranial migration of the disc material. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis elsewhere within the thoracic spine.
1. Edema and enhancement involving the C6 and C7 vertebral bodies with mild extension into the paravertebral region is suspicious for C6-C7 discitis-osteomyelitis. No discrete fluid collection to suggest abscess. No findings to suggest osteomyelitis in the thoracic spine.2. Degenerative changes in the cervical spine as detailed above including neural foraminal stenoses at the C5-C6 and C6-C7 levels. There is also mild spinal canal stenosis at C5-C6. No high-grade spinal canal stenosis or cord signal abnormality at any level. 3. Small central disc extrusion at the T7-T8 level which contacts the ventral thoracic cord but without significant spinal canal stenosis overall at this level. 4. Bilateral pleural effusions as seen on recent CT. Approximately 2 cm right thyroid nodule also again seen.