Diagnosis: Fracture of neck, unspecified, subsequent encounterClinical question: pre op planning for C1-2 fractureSigns and Symptoms: C1 C2 fracture The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is anterior subluxation of C3 on C4.At C1-2 there is some hypertrophy of the tissues at the cruciate ligaments which is associated with narrowing of the spinal canal. The odontoid appears to be chronically fractured. There are signal changes within the odontoid process . These findings are stable when compared to the prior exam. There is mild posterior subluxation of C1 relative to C2.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disk space height associated with endplate reactive changes and bilateral facet hypertrophy. There is anterior subluxation of C3 on C4 with resultant narrowing of the spinal canal and bilateral neural foramina. There is encroachment of the exiting nerve roots. The spinal cord is surrounded by spinal fluid at this level. There is no significant change in this appearance when compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height at this level with near obliteration of the disk space and osseous bridging. There is associated bilateral facet hypertrophy at this level associated with fusion across the left facet joint. Findings were also present on the prior exam.At C5-6 there is no significant compromise to the spinal canal. There is loss of disk space height and disc desiccation. There is a also diffuse disk bulge and bilateral uncovertebral and endplate osteophytes with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height and disk desiccation as well as bilateral uncovertebral osteophytes and some posterior ligamentous hypertrophy at this level. There is bilateral neural frontal narrowing with encroachment of exiting nerve roots at this level. This appears stable compared to prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is smaller than the right vertebral arterySome scattered opacities are present in the right mastoid air cells.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right lobe of the thyroid gland appears heterogeneous within a 2 cm region. This appears stable and compared to an MRI of the cervical spine from 3/29/2013.
1.There are multilevel degenerative changes present in the cervical spine. These findings are stable compared to the previous exam. 2.There is pannus formation along the cruciate ligaments at the C1 C2level which narrows the spinal canal mildly but does not compress the spinal cord or brainstem. There is a chronic odontoid fracture present. There is stable posterior subluxation of C1 relative to C2. These findings are stable compared to the previous exam.3. There is anterior-subluxation of C3 on C4 associated degenerative changes and mild spinal stenosis associated with encroachment of exiting nerve roots. These findings are stable compared to the previous exam.4.There degenerative changes present at C5-6 and C6-7 with bilateral neural foramen encroachment encroachment of exiting nerve roots. These findings are stable compared to the previous exam.5.No evidence for carotid or vertebral stenosis in the neck.6.There is heterogeneity and enlargement of the right thyroid gland lobe. This is a nonspecific finding. It is stable compared to the prior exam.