Progressive numbness, weakness in left upper extremity. Low back pain with or without sciatica. Evaluate for possible nerve root compression or other CNS pathology. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with disc height loss at multiple levels, relatively worse at the C4-C5, C5-6, and C6-C7. Individual levels 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: Right paracentral and foraminal disc osteophyte complex with effacement of the right ventral thecal sac. No significant spinal canal stenosis overall. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex with uncovertebral hypertrophy result in moderate to severe bilateral neural foraminal stenosis, left slightly worse than right. Mild spinal canal stenosis. C6-7: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing related to uncovertebral hypertrophy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L2 on L3 and trace retrolisthesis of L3 on L4. There is also mild anterolisthesis of L5 on S1. There is disc desiccation throughout the lumbar spine with suggestion of vacuum phenomena at the L4-L5 and L5-S1 levels. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and mild bilateral facet arthropathy. There is no significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L3-L4: Mild disc bulge, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Mild disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is also prominence of the dorsal and ventral epidural fat resulting in moderate spinal canal stenosis. There is clumped appearance of the nerve roots which is favored to be related to extrinsic compression. There is moderate to severe right neural foraminal stenosis and moderate left neural foraminal stenosis. There are mild edematous changes involving the endplates which are likely on a degenerative basis.L5-S1: There is advanced bilateral facet arthropathy and grade 1 anterolisthesis. There is no significant spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.There is mild fatty atrophy involving the lower lumbar paraspinous musculature.
1. Multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at C5-C6 and C6-C7. No high-grade spinal canal stenosis or cord signal abnormality. There is multilevel neural foraminal stenosis, relatively worst at the left C5-C6 level where there may be impingement of the left C6 nerve root. Additional levels as above.2. Multilevel degenerative changes in the lumbar spine. There is up to moderate spinal canal stenosis at the L4-L5 level. There is also significant neural foraminal stenosis bilaterally at L4-L5 and L5-S1, right worse than left, as described above where there may be impingement of the exiting nerve roots.3. Advanced bilateral facet arthropathy at L5-S1 and to a lesser degree at L4-L5, which may be contributing to patient's low back pain.