Diagnosis: Neoplasm of unspecified nature of bone, soft tissue, and skinClinical question: 3 month f/u eval schwannoma for change The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.The patient is status post posterior fusion with the lateral mass screws on the left side at C2, C3 and C4 and on the right side at C2 and C4. There are associated interconnecting rods. The patient is status post right-sided laminotomy at this level.At C2-3 there is a 9 x 7 mm axial dimension ring-enhancing lesion within the right neural foramen this was not clearly present on the prior exam from March.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy at this level - right more than left.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with moderate bilateral neural foramina encroachment of exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is loss of disk space height at this levelAt C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with bilateral neural foramina encroachment (right worse than left) and some mild narrowing of the spinal canal . There is encroachment of right-sided exiting nerve roots. There is loss of disk space height at this level.At C7-T1 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level mildly narrowing the neural foramina.The vertebral artery flow voids appear to be intact.There is redemonstration of some signal changes in the visualized portions of the pons which can be better visualized on the MRI of the brain from 2/4/2015
1.Since previous examination a nodule has developed in the right neural foramen at C2-3. The possibility that this represents recurrence or residual tumor cannot be excluded.2.The patient is status post surgery at C2-3 as detailed above.3.There are some degenerative changes present in the cervical spine which remains stable since prior exams. This appears to be worse at C5-6 and C6-7 where there is encroachment of exiting nerve roots bilaterally at C5-6 and on the right side at C6-7.4.Signal changes in the brainstem are better evaluated on the MRI of the brain from 2/4/15.