Clinical question: Patient with radiculopathy persistent despite physical therapy. Evaluate for pathology. Signs and symptoms: Neck and scapular pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is mild generalized smaller than expected caliber of spinal canal which is believed to be at least partially secondary to congenitally short pedicles.Foramen magnum is unremarkable.C2-C3 demonstrate a tiny central disc protrusion best appreciated on axial T2 series 902 image 27. Mild central spinal stenosis and no convincing evidence of neural foraminal compromise.C3-C4 demonstrate mild disc desiccation and loss of disc height and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and bilateral neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and facet disease. There is mild central spinal stenosis and left neural foraminal compromise. There is a tiny focus of increased T2 STIR signal intensity projecting lateral to the left articulating facet suspicious for focus of effusion or a tiny synovial cyst.C5-C6 demonstrate mild degenerative disc disease with shadow bilateral (right greater than left) uncovertebral hypertrophic changes is noted. Mild central spinal stenosis, moderate left and mild right neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophic changes. There is a right-sided disc-osteophyte complex at this level with resultant significant right neural foraminal compromise. Mild central spinal stenosis and moderate to severe left neural foraminal compromise is also present.C7-T1 demonstrates significant asymmetric left-sided facet and ligamentum flavum hypertrophic changes without spinal stenosis or neural foraminal compromise.Examination also demonstrates patchy foci of T2 hyperintensity within the cervical cord which is best appreciated on sagittal images and centered primarily at C5 and C6 levels. Findings are believed to represent myelitis secondary to degenerative disease.
1.Uniform generalized smaller caliber of the spinal canal believed to represent congenitally small canal.2.Multilevel mild degenerative changes in combination with congenitally small canal results in multilevel mild central spinal stenosis.3.There is a left-sided disc/osteophyte at C6-C7 level with resultant significant neural foraminal compromise.4.Multilevel neural foraminal compromise as detailed per level above.5.T2 hyperintensity of the cervical cord at C5 and C6 levels concerning for myositis secondary to degenerative disease.