Reason: Eval for progression, cervical stenosis History: arm numbness and weakness Cervical spine:The cervical vertebral bodies are appropriate in overall height. The patient is status post laminectomies at C2, C3, C4, C5, C6 and C7. There is anterior fusion of C5, C6 and C7. There is reversal of the normal cervical curvature in the upper cervical spine especially at C3-4 and C4-5. There is mild anterior subluxation of C3 on C4 of approximately 4 mm with resultant spinal stenosis. There is myelomalacia present along the lower cervical spinal cord .At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At C3-4 there is 4 mm subluxation of C3 on C4 associate bilateral facet hypertrophy and narrowing of the spinal canal with effacement of spinal fluid ventral posterior the spinal cord. There are uncovertebral osteophytes present at this level as well as disk bulge. There is bilateral neural foramen encroachment of the exiting nerve roots at this level.At C4-5 there is disk desiccation as well as uncovertebral osteophytes and a disk bulge associated with bilateral facet hypertrophy. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C5-6 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine.There is a heterogeneously hyperintense lesion present within the distal sacral spinal canal was also present on the prior exam as well as an exam from 2/8/13 that does not appear to have changed substantially. This is associate with some expansion of the sacral spinal canal. At L5-S1 there is a redemonstration of anterior subluxation of L5 on S1 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level and mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is moderate to severe spinal stenosis at this level.At L4-5 there is a redemonstration of anterior subluxation of L4 on L5 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level. There is obliteration of spinal fluid surrounding the nerve roots at this level. There is mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is severe spinal stenosis at this level.At L3-4 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with a moderate degree of facet hypertrophy there is partially effacement of the fat at the lateral recesses at this level with triangulation of the thecal sac. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a mild to moderate degree of spinal stenosis at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.There is mild retropulsion of T12 on L1. There is no significant compromise to the spinal cord at this level
1.The patient is status post multilevel laminectomies from C2 down to C7 and anterior fusion from C5 through C7.2.There is subluxation with spinal stenosis associated degenerative changes at C3-4 which appears stable when compared to the prior exam.3.There are multilevel degenerative changes present with neural foramen encroachment at multiple levels.4.There is reversal of the normal cervical curvature present. There is a mild levocurvature to the lower cervical spine .5.There is myelomalacia present in the lower cervical spinal cord.6.There are multilevel degenerative changes in the lumbar spine due to disk disease and facet disease resulting in severe spinal stenosis at L4-5 associated with mild subluxation and moderate to severe spinal stenosis at L5-S1 associated with mild subluxation. These findings are stable when compared to the previous exam.7.There is a lesion present in the distal sacral spinal canal centered at the S3 level which appears to be long-standing and associated with expansion of the spinal canal. It appears to be partly hemorrhagic in nature. It affects the nerve roots in the distal sacral spinal canal.