Neck pain and bilateral upper extremity numbness and tingling. Evaluate for cervical stenosis. Low back pain and radiculopathy. History of previous lumbar surgery. Evaluate for scar tissue. CERVICAL SPINE:There is reversal of the normal cervical lordosis, which may be in part positional. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at C5-C6 and C6-C7, where degenerative disc-osteophyte complexes cause mild-to-moderate spinal canal stenosis as described below. Small anterior osteophytes are also present at these levels. Accounting for that and a hemangioma in C3 vertebral body, there is no significant marrow abnormality. The cervical spinal cord is normal in signal and shape. Included posterior fossa structures and upper thoracic spinal cord are unremarkable as well.C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: Minimal disc-osteophyte complex barely indents the ventral thecal sac. Uncovertebral and facet arthropathy cause moderate right and mild left neural foraminal stenoses.C4-C5 and C5-C6: Disc-osteophyte complex causes mild central/left paracentral spinal canal stenosis. Facet and uncovertebral arthropathy causes moderate left C5-C6 and mild right C5-C6 and mild left C4-C5 neuroforaminal stenoses.C6-C7: The disc-osteophyte complex on this level causes mild-to-moderate spinal canal stenosis. Facet and uncovertebral arthropathy causes mild neuroforaminal stenoses.C7-T1: There is no spinal canal or neural foraminal stenosis.The internal carotid arteries show medial, retro-/parapharyngeal course, which is a normal variation. A partially empty sella is probably an incidental finding.LUMBAR SPINE:There are 5 lumbar-type, nonrib-bearing vertebrae. The last well-formed disc is at L5-S1.Sagittal alignment is notable for minimal degenerative anterior subluxation of L4 on L5 and L5 relative to S1, associated with desiccation of the respective discs. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at L5-S1. The spinal canal is narrowed at L5-S1 as described below. The tip of the conus medullaris lies at the lower L1 level. The conus medullaris and the included caudal part of the spinal cord show normal signal and shape.There are changes of previous posterior decompressive surgeries at L4-L5 and L5-S1 levels, where there are changes of bilateral laminotomies at both levels. Contrast-enhancing tissue is present at the surgery site and extending into the posterior and lateral epidural spaces at both levels. At L4-L5, there has been resection of the thickened ligamenta flava with resolved central and paracentral spinal canal stenosis. Minimal disc bulge and uncovering remain unchanged. The contrast-enhancing scar tissue extends into the posteromedial inferior aspect of the neural foramina without displacing or encasing the nerve roots. Neural foraminal stenoses remain mild-to-moderate, worse on the right. At L5-S1, the thecal sac is congenitally small with superimposed minimal anterior subluxation of L5 on S1. Prior laminectomy and partial facetectomies. There is prominent scar tissue abutting the bilateral S1 nerve roots.L1-L2, L2-L3, L3-L4 and L4-L5: There is no significant disc herniation and there is no spinal canal or foraminal stenosis. There is mild facet arthropathy and mild-to-moderate ligamenta flava thickening, which are worse in the lower levels.There are mild degenerative changes at the sacroiliac joints. Tiny sclerotic focus in the right iliac bone may represent a bone island. T1-hypointense, T2-hyperintense, and contrast-enhancing lesions in the kidneys likely represent cysts.
1.Mid cervical degenerative disease results in mild-to-moderate C6-C7 and mild C4-C5 and C5-C6 spinal canal stenosis. No high-grade cervical spinal canal stenosis. Neural foraminal stenosis is moderate on the right at C3-C4 as well as on the left at C5-C6 and mild at other levels as described above.2.Resolved spinal canal stenosis at L4-L5 following posterior decompression as described above. Thecal sac remains diminutive at the L5-S1 level which is likely combination of congenital narrowing, epidural fat, minimal anterolisthesis, and epidural scar tissue. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.