Clinical question:? Spinal stenosis. Signs and symptoms: Radicular arm and leg pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild to moderate degenerative changes resulting in severe right and moderate left neural foraminal compromise and moderate central spinal stenosis.C4-C5 demonstrate moderate degenerative changes resulting in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C5-C6 demonstrate moderate to advanced disc disease and to a lesser degree degenerative/hypertrophic changes of posterior elements. Findings results in moderate central spinal stenosis and significant (right greater than left) neural foraminal compromise.C6-C7 demonstrate moderate to advanced disc disease and loss of disc height with mild hypertrophic changes of posterior elements. There is mild central spinal stenosis and moderate left and mild to moderate right neural foraminal compromise.C7-T1 is unremarkable with the exception of mild degenerative changes.The signal intensity of the cervical and upper most visualized thoracic cord remains within normal.Nonenhanced thoracic MRI:There is normal anatomical alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of central spinal stenosis at any level.T1-T2 is unremarkable.T2-T3 is negative for spinal stenosis or neural foraminal compromise. There is however a small) median disc protrusion with resultant mild effacement of ventral subarachnoid space (axial T2 series 12 image 13).T3-T4 is unremarkable.T4-T5 is unremarkable.T5-T6 is unremarkable.T6-T7 is unremarkable.T7-T8 is unremarkable.T8-T9 demonstrate mild left neural foraminal compromise and unremarkable otherwise.T9-T10 demonstrate moderate right and mild left neural foraminal compromise.T10-T11 demonstrate moderate right and mild left neural foraminal compromise.T11-T12 is unremarkable.T12-L1 is unremarkable.Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative disc disease and mild bilateral ligamentum flavum hypertrophy and minimal facet disease. No central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and left facet effusion. There is mild grade 1 retrolisthesis. Constellation of changes results in mild central spinal stenosis and moderate right and mild left neural foraminal compromise. Examination also demonstrates a focus of increased T2 signal intensity within the annulus of the disc in the right para median location suggestive of an annular fissure.L3-L4 demonstrate mild degenerative disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however mild to moderate bilateral (right greater than left) neural foraminal compromise is present.L4-L5 mild disc disease and loss of disc, shallow broad-based bulging disc, moderate to significant bilateral ligamentum flavum hypertrophy, mild facet disease however with evidence of bilateral facet effusion. There is a tiny synovial cyst within the left ligamentum flavum without significant mass effect. Constellation of findings results in moderate central spinal stenosis and significant right and moderate left neural foraminal compromise. Tiny synovial cysts is also noted projecting to the left of the spinous process and posterior to the right articulating facet.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however mild bilateral neural foraminal compromise is present.
1.Nonenhanced MRI of cervical spine demonstrate degenerative changes throughout the cervical spine involving the discs and posterior longitudinal ligament and to a lesser degree of the posterior elements. Findings results in multilevel central spinal stenosis at C3-C4, C4-C5, C5-C6 and to a lesser degree at C6-C7 levels as well as multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. The signal intensity of the cord remains within normal.2.Nonenhanced MRI of thoracic spine demonstrate mild to moderate disc disease and mild hypertrophic changes of posterior elements. There is no central spinal stenosis. There are however multilevel mild to moderate neural foraminal compromise as detailed per level above. The signal intensity of the cord remains within normal.3.Nonenhanced MRI of lumbar spine demonstrate moderate central spinal stenosis at L4-L5 and mild spinal stenosis at L2-L3. Multilevel neural foraminal compromise as detailed per level. Multilevel facet effusion and tiny synovial cysts as detailed.