 Please note: On the prior exam, the level with the worst degenerative findings was stated to be C4-5, however it is in fact at C3-4. There is mild edema within the C4, C5 and C6 vertebral bodies with mild loss of height as noted before. There is a congenitally narrowed spinal canal with superimposed findings as described below.C2-3: No spinal canal or neural foraminal stenosis.C3-4: Posterior disk osteophyte complex causing persistent focal indentation of the spinal cord without significant change. There is stable focal T2 signal abnormality within the cord, with associated ill-defined long segment T2 signal abnormality within the cord above and below this level and mild expansion of the cord caliber without significant change. However, there is more conspicuous predominantly peripheral enhancement along the spinal cord at this level. There is mild bilateral neural foraminal compromise.C4-5: Posterior disk osteophyte complex causing mild/moderate spinal canal stenosis, and mild bilateral neural foraminal compromise. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C5-6: Posterior disk osteophyte complex causing mild spinal canal stenosis and severe left neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C6-7: Posterior disk osteophyte complex with no significant spinal canal stenosis, and mild right neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C7-T1: No spinal canal or neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.
1.Persistent cervical myelopathy most pronounced at C3-4 level where there is focal impingement of the cord from a posterior disk osteophyte complex. Compared to the prior study, there is more conspicuous peripheral enhancement at this level which does not appear masslike. Differential diagnosis includes reactive changes secondary to chronic spondylotic impingement of the cord, demyelination, non-infections inflammation, and less likely a chronic infection. Neoplasm is felt to be unlikely given the imaging characteristics.2.Persistent degenerative changes in the cervical spine contributing to multilevel cervical spinal canal and neural foraminal stenoses, without significant change.