Clinical question: Evaluate for left leg weakness. Signs and symptoms: Left leg weakness. Pre and post enhanced cervical MRI:There is normal signal intensity and anatomical alignment of the vertebral column.Foramen magnum is unremarkable.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative disease without spinal or neural foraminal compromise.C3-C4 demonstrate moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophic changes. There is a central disc protrusion with mass effect and flattening deformity and posterior displacement of the cord and result in moderate central spinal stenosis. Moderate right and mild to moderate left neural foraminal compromise is also noted at this level. The signal intensity of the cord remains within normal at this level.C4-C5 demonstrate mild degenerative changes and a tiny central disc protrusion with resultant subtle deformity of the ventral aspect of the cord however without central spinal stenosis or neural foraminal compromise. Normal signal intensity of the cord at this level.C5-C6 demonstrates moderate disc disease and loss of disc height, minimal facet and ligamentum flavum hypertrophy and without spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease with near complete loss of disc height, mild facet and ligamentum flavum degenerative changes. There is a central and left paramedian broad-based disc-osteophyte at this level with resultant mass effect, flattening deformity and posterior displacement of the cord, nearly complete effacement of subarachnoid space and moderate central spinal stenosis. Moderate right and mild left neural foraminal compromise is also detected. Examination at this level demonstrate linear increased T2 STIR signal intensity within the anterior cord which is best appreciated on sagittal T2 STIR series 5 image 11. Finding is highly suspected myelopathy secondary to degenerative spondylosis. Prior cervical MRI exam from MRI of River North dated 3-2-15 is of suboptimal quality and without sagittal T2 STIR series.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Degenerative changes of cervical spine and loss of disc height results in mild reversal of cervical lordosis. Incidental note is made of a small fluid signal intensity cyst like lesion in the superior left nasopharynx suspected of a Tornwaldt cyst.There is a well-demarcated enhancing focus of T2/T2 STIR hyperintense ( 7 x 5.5 mm sagittal T2 series 3 image 9) and mildly hyperintense on T1-weighted images in the vertebral body of C5. Post enhanced images demonstrate expected subtle enhancement of degenerative changes.Pre and post enhanced thoracic MRI: There is normal anatomical alignment of vertebral column.There is no appreciable significant degenerative changes of thoracic spine.There is no evidence of spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement.There is a small focus of T2 STIR hyperintensity (10 x 6 mm on axial T2 series 2 and T2 image 8) and T1 hypointense with enhancement in the posterior aspect of T9 vertebral body. Additional punctate focus of enhancement noted in the T7 vertebral body which cannot be identified with certainty on any other MRI sequence.Pre and post enhanced lumbar spine:The alignment of the vertebral column is normal and with evidence of grade 2 anterolisthesis at L5-S1 level. Examination demonstrates extensive postoperative changes of a posterior approach for spinal fusion. There are fixating rods as well as transpedicular screw placement on the right at L3, bilaterally at L4, bilaterally at S1 levels.There is no evidence of spinal stenosis. However significant bilateral neural foraminal compromise at L5-S1 level is detected.There is normal signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement. Note should be made that extensive metallic hardware artifact makes precise evaluation difficult.
1.MRI of cervical spine demonstrate diffuse degenerative changes with reversal of cervical lordosis, disc protrusion and disc-osteophyte complex which results in mild to moderate central spinal stenosis at C3-C4 and moderate stenosis at C6-C7 levels. Increased T2 STIR signal intensity of the cord at C6-C7 level suspected for myelopathy. Multilevel neural foraminal compromise as detailed per level above. Please see detailed report above.2.Pre and post enhanced MRI of thoracic spine demonstrate normal signal intensity and caliber of thoracic cord without abnormal enhancement. No intravenous or spinal stenosis or neural foraminal compromise.3.Pre and post enhanced MRI of lumbar spine demonstrate extensive postoperative changes of posterior fusion and including placement of posterior rods and transpedicular screws for grade 2 anterolisthesis at L5-S1 level. No spinal stenosis is detected. Significant bilateral neural foraminal compromise bilaterally at L5-S1 is present.4.Small foci of marrow signal changes with enhancement noted in the vertebral bodies of C5, T7 and T9 levels. The appearance is suggestive of a benign process however less likely possibility of metastatic disease should also be considered and follow-up exams is recommended. Please see detailed report /measurements above.5.There is no detectable abnormal enhancement of the cord or the leptomeninges.