44 years Female (DOB:5/4/1971)Reason: hx cervical spondylosis. Eval abnormality/stenosis History: neck pain, left arm painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present this level which impresses on the ventral aspect of the thecal sac and partially effaces spinal fluid ventral to the spinal cord. There are some endplate reactive changes at this level which are high signal on T2 imaging and low signal on T1 imaging.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are small T2 hyperintense foci in the right thyroid lobe measuring up to 6 mm in diameter.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There are some endplate reactive changes present there is some mild ligamentum flavum hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 4 cm cyst present along the right kidney along its inferior pole.
1.There are degenerative changes present in the cervical spine which are worse at C4-5 where there are subacute endplate reactive changes and a central disc protrusion without significant compromise to the spinal canal or exiting nerve roots.2.There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.3.There is a cyst along the right kidney.