Lower extremity weakness, concern for cord compression. Compared to 12/29/2014, there is interval increase in destructive changes at the C6-C7 disc level including the adjacent C6 and C7 vertebral bodies with loss of vertebral body height. T2 hyperintensity involving the disc space and bone marrow compatible with edema is stable to minimally increased in the interval. There is a dorsally projecting osteophyte/osseous retropulsion which results in flattening of the cord which is worse since prior. There is also increased T2 hyperintensity in the cord compatible with edema. There is mild edema involving the prevertebral soft tissues which appears overall decreased since 12/29/2014, but is slightly increased at the C6-C7 level.There is T2 hyperintensity in the ventral epidural space extending from C5 to C7 which is favored to represent engorged epidural venous plexus.Diffuse low T1 and T2 bone marrow signal may be related to renal osteodystrophy and/or chronic anemia. Individual levels as below:C2/3: Minimal posterior osteophyte disc complex without spinal canal or neural foraminal stenosis.C3/4: Posterior osteophyte complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is moderate spinal canal stenosis and mild bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild right facet hypertrophy. There is moderate spinal canal stenosis and mild to moderate bilateral neuroforaminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C6/7: See above. There is severe spinal canal stenosis at this level which has progressed with also new T2 cord signal abnormality. There is severe right and moderate to severe left neural foraminal stenosis..C7/T1: No significant spinal canal or neural foraminal stenosis.
1. Examination is compared to 12/29/2014. Again seen are endplate destructive changes with edema centered at the C6-C7 level with interval worsening of height loss of the C5 and C6 vertebral bodies and worsened osseous retropulsion. Associated spinal canal stenosis has also worsened and is now severe. There is also new T2 hyperintensity in the cord at the C5-C6 level likely representing edema related to compression. Extent of osseous destruction and retropulsion may better assessed on CT.2. T2 hyperintensity involving the subligamentous anterior epidural space from C5 to C7 is favored to represent engorged venous plexus. Epidural abscess seems less likely based on the morphology although postcontrast images would be helpful. Differentials for the above destructive process include dialysis-related spondyloarthropathy and chronic infection.3. Multilevel cervical spinal canal stenosis and neural foraminal stenosis at additional levels is similar to prior and detailed above.