62-year-old male experiencing worsening back pain, history of Chiari, syrinx, tethered cord Cervical:There is a mild reversal of the normal cervical lordosis. Partial fusion is again seen across the C3-4 intervertebral disk. Vertebral body heights are normal. There is a benign hemangioma within the C6 vertebral body. No worrisome marrow replacement or marrow edema is detected.The cerebellar tonsils extend slightly below the level of the foramen magnum, more so on the right where descent below the foramen is approximately 3 mm. The tonsils remain relatively rounded. These findings are unchanged.Prominence of the central canal spinal cord is demonstrated beginning at approximately C5 and extending into the thoracic region. The caliber of the central canal reaches 2 mm at its maximum. These findings are unchanged.C2-3: No spinal canal stenosis or neuroforaminal narrowing, unchanged. C3-4:Osteophytic ridging asymmetric to the left paracentral and foraminal zones. This results in effacement of the left ventral thecal sac and mild flattening of the spinal cord. No cord signal abnormality is seen. The left neural foramen is moderately narrowed. No interval changes.C4-5: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.C5-6: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes.C6-7: Minimal posterior disk osteophyte formation. No spinal canal stenosis. No foraminal narrowing. No interval changes. C7-T1: Unremarkable and unchanged. Thoracic:Previously demonstrated marrow edema within the anterior aspect of the T11 vertebral body has decreased, and there is a slight increase in marrow edema involving the anterior vertebral body of T10. As before, there is a large bridging osteophyte across these vertebral bodies, thus the edema is felt to be secondary to spondylitic reactive endplate change. A T1/T2 dark band which traverses the anterior/inferior corner of the T11 vertebral body is unchanged relative to prior examinations and corresponds to a sclerotic band on CT. Marrow edema is also seen along the T4-5 disk and in the T4 vertebral body is unchanged, also at a level where there is a large anterior osteophyte. Vertebral body heights are preserved. Spinal alignment is anatomic.As above, prominence of the central spinal canal begins in the cervical region and continues to the T1-2 level. Intermittent mild prominence of the central canal begins again at the T3-4 level and continues to approximately the T7-8 level, unchanged. As before, the spinal cord is somewhat diminutive, particularly at lower levels.No evidence of significant disk disease, spinal canal or neuroforaminal stenosis is seen in the thoracic spine. Mild facet hypertrophy is evident at some levels.Postoperative scarring is seen within the soft tissues of the lower thoracic region and there is evidence of surgical deformity of the posterior elements at T9-10.Lumbar:The L5 vertebral body demonstrates a mild transitional morphology. Vertebral body height is preserved. No concerning marrow replacement or evidence of marrow edema is seen.Absence of posterior elements is redemonstrated at least partially at L4 and from L5 through the sacrum region. The spinal cord remains low-lying descending at least to the L5 level ultimately thinning and fanning out and blending with a network of soft tissue strands which traverse the lower thecal sac. These findings are unchanged.The spinal cord is congenitally narrow particularly from L2 through L3. Additional level specific findings are as follows:L1-2: Marked facet hypertrophy and ligamentum flavum thickening. Minimal disk bulge. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged. L2-3: Marked facet hypertrophy. Ligamentum flavum thickening. Diffusely bulging disk. Central stenosis has progressed from moderate to severe to now severe central stenosis. Moderate bilateral foraminal narrowing. L3-4: Marked facet hypertrophy and mild ligamentum flavum thickening. Bulging disk. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged.L4-5: Marked facet hypertrophy. Bulging disk with central protrusion. No spinal canal stenosis. Mild bilateral foraminal narrowing. These findings are unchanged.L5-S1: Marked facet hypertrophy. No spinal canal stenosis. No foraminal narrowing. These findings are unchanged.
1.Stable low lying cerebellar tonsils.2.Prominence of the central canal of the spinal cord beginning in the cervical region and continuing in discontinuous fashion through the thoracic region are unchanged.3.Low lying spinal cord which continues at least to the L5 level where it begins to thin and fan out, ultimately terminating in a network of soft tissue strands which traverse the lower thecal sac, unchanged.4.At L2-3 central stenosis has progressed from moderate to severe to now severe central stenosis. 5.Stenoses elsewhere are stable and described in detail above.