Clinical question: Evaluate back pain. Signs and symptoms: Persistent back pain. Pre and post enhanced cervical MRI:.Similar to prior brain MRI exam from3/4/2015 there is redemonstration of mild dorsiflexion of the dens and suggestion of subtle platybasia without change since prior exam.Similar to prior brain MRI examination there is 5.5 mm space between the anterior arch of C1 and dens with fatty signal intensity within this space. The measurement is at the upper limits of normal. Clinical significance of this finding is questionable. If patient has symptoms relevant to this region further evaluation and including flexion and extension views would be helpful for further assessment. Also unusual for patient's stated age of 11 there are tiny linear T2stir hyperintensity within the annulus of the disc at C4-C5 and C5-C6 levels (sagittal T2 STIR series 501 images 8 and 9) which demonstrate subtle enhancement. This appearance in adult population represents annular fissure and unusual for pediatric age group. Clinical significance of this finding also remains questionable.No detectable abnormality at the level of foramen magnum. The alignment of cervical spine is anatomical. The signal intensity and caliber of the cervical cord is within normal.No evidence of spinal canal or neural foraminal compromise at any level. Post enhanced images are unremarkable other than above mentioned finding.Pre and post enhanced thoracic MRI:There is normal anatomical development, signal intensity and alignment of the vertebral column. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and caliber of the cord. No abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.No detectable paraspinal soft tissue abnormalities.Pre and post enhanced lumbar MRI:There is normal anatomical development, normal signal intensity and alignment of lumbar spine. No spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity of the lower most visualized thoracic cord and conus. There is termination of the cord at L1 level.There is a tiny uniform linear fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level which is best appreciated on axial T1 series 2401.Although there is normal termination of the cord at L1 level to entirely exclude possibility of tethered cord follow up with prone sagittal T2-weighted images is recommended.
1.MRI of cervical spine demonstrate normal signal intensity and caliber of the cord without abnormal enhancement. No spinal stenosis or neural foraminal compromise. Mild platybasia, 5.5 mm space between the anterior arch of C1 and dens at the upper limits of normal, tiny signal changes and enhancement in the annulus of the disc at C4-C5 and C5-C6 levels consistent with annular fissure which is an unusual finding for this age group. Please see above comments.2.MRI of thoracic spine is unremarkable.3.Pre- and post enhanced MRI of lumbar spine demonstrate a tiny uniform fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level. There is termination of the cord at upper L1 level. Unremarkable lumbar MRI otherwise. To entirely exclude possibility of tethered cord follow-up with prone sagittal T2-weighted images is recommended.