Clinical question: Evaluate for myelopathy, foraminal stenosisSigns and Symptoms: B/L LE weakness, numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present. The patient is status post laminectomies at C3, C4, C5, C6. Patient is status post posterior fusion at C3 through C6. There is multilevel disc desiccation present. There is loss of disc space height at C3-4, C4-5, C5-6, C6-7 and C7-T1.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level. There is some mild narrowing of the left neural foramen at this levelAt C3-4 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion present at this level. There is encroachment of the left-sided exiting nerve roots at this level due to disc material and some uncovertebral osteophytes.At C4-5 there is no significant compromise to the spinal canal. There are some mild encroachment of the left-sided exiting nerve roots at this level due to disc material and osteophytesAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the neural foramina at this level due to degenerative changes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the neural foramina at this level due to degenerative changes.At C7-T1 there is a broad-based central disc protrusion present which impresses on the ventral aspect of the thecal sac and is associated with effacement of spinal fluid ventral and posterior to the spinal cord. There is posterior ligamentous hypertrophy present at this level contributing to the spinal stenosis. Overall there is a mild to moderate degree of spinal stenosis present at this level. Additionally there is encroachment of the exiting nerve roots bilaterally at this level due to disc material.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are some mild multilevel degenerative changes present thoracic spine without significant compromise to spinal canal or exiting nerve roots.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some ligamentum flavum hypertrophy present at this level. There are subchondral cysts present on the right side facet joint.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is subchondral cyst on the left facet joint.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.The patient status post cervical spine surgery with laminectomy and fusions from C3 through C6. 2.There is a mild to moderate degree of spinal stenosis at C7-T1 associated with encroachment of the exiting nerve roots bilaterally.3.There are mild degenerative changes present in the thoracic and lumbar spine without significant compromise to the spinal canal or exiting nerve roots.4.No intrinsic spinal cord lesion is appreciated.