History of ACDF C3-C4. Gunshot wound to lower back. Lower extremity pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. There are postsurgical changes of ACDF at the C3-C4 level, hardware which can be better assessed with CT or radiographs.There is abnormal T2 signal within the cervical cord at the C3-C4 level consistent with myelomalacia and unchanged since 6/5/2013.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. Mild neural foraminal narrowing bilaterally related to uncovertebral hypertrophy and mild facet arthropathy.C3-4: Abnormal signal involving the bilateral aspects of the cord with mild volume loss. There is mild spinal canal narrowing with partial effacement of the ventral and dorsal thecal sac. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy.C4-5: Mild disc bulge and bilateral uncovertebral hypertrophy. Mild narrowing of the spinal canal. There is moderate to severe right and mild-to-moderate left neural foraminal stenosis.C5-6: No significant compromise to the spinal canal. There is moderate right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Left paracentral disc osteophyte complex with bilateral uncovertebral hypertrophy. There is mild narrowing of the left aspect of the spinal canal no significant spinal canal stenosis. There is moderate left greater than right neural foraminal stenosis.C7-T1: Small central disc protrusion without significant spinal canal stenosis. Mild left and minimal right neural foraminal narrowing.No abnormal enhancement. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures are unremarkable.THORACIC SPINE
1. Postsurgical changes of ACDF at C3-C4 with myelomalacia involving the cervical cord at the C3-C4 level presumably related to prior compressive myelopathy. No significant change since prior cervical spine MRI study from 6/5/2013. There is mild degree of spinal canal narrowing at C3-C4, C4-C5, and C6-C7. No high-grade spinal canal stenosis. Multilevel neural foraminal narrowing in the cervical spine as detailed above.2. Post surgical changes of laminectomy from T7 to T10. Spinal canal is well decompressed. Abnormal T2 signal is noted involving the dorsal thoracic cord at the T9-T10 level. No prior thoracic imaging is available for comparison, but finding is consistent with remote cord injury. Mild multilevel degenerative changes in the thoracic spine are seen including neural foraminal narrowing as detailed above.3. Postsurgical changes in the lumbar spine related to spinal canal decompression at the L3-L4 and L4-L5 levels. Spinal canal at these levels is well decompressed. There is mild narrowing of the lumbar spinal canal at the L2-L3 level which appears similar to prior from 4/10/2013. Multilevel relatively mild lumbar neural foraminal narrowing as detailed above.