Clinical question: Cord compression. Signs and symptoms: Right upper and lower extremity weakness. Unenhanced cervical MRI:Examination demonstrates degenerative changes of cervical spine, post operative changes of an anterior fusion of C3, C4 and C5 levels similar to prior exam.Foramen magnum is unremarkable.C2 -- C3 a broad-based disk protrusion (more prominent on the right) which is new since prior exam. This finding in combination with significant hypertrophic changes of ligamentum flavum posteriorly results in complete effacement of subarachnoid space, flattening deformity of the cord and moderate to severe central spinal stenosis. There is no convincing evidence of cord signal abnormality/edema at this level. There is significant left and mild right neural foraminal compromise.C3 -- C4 demonstrate expected postoperative changes of anterior fusion and posterior laminectomy without significant change since prior exam. There is flattening deformity of the cervical cord secondary to ventral hypertrophic changes, significant bilateral (right greater than left) neural foramina are compromised which all remain stable since prior exam. There is diffuse cord signal abnormality and decreased caliber extending from approximately C3 inferiorly to C5 -- C6 disk level similar to prior exam and consistent with cord myomalacia.C4 -- C5 demonstrate expected post op changes of prior anterior fusion, posterior laminectomy, expansion of thecal sac, significant right and moderate left neural foraminal compromise. There is no evidence of interval change since prior study.C5 -- C6 demonstrate slight forward angulation of the cervical spine similar to prior exam. Mild central spinal stenosis, significant bilateral neural foraminal compromise remain all similar to prior study.C6 -- C7 demonstrate mild-to-moderate degenerative changes without convincing evidence of central spinal stenosis. Moderate to significant bilateral neural foraminal compromise without change since prior study.C7 -- T1 demonstrate moderate disk disease and loss of disk height prominent bilateral ligamentum flavum hypertrophy, mild central spinal stenosis, significant left and moderate right neural foraminal compromise. There is no significant interval change in the extent of the findings since prior study.
1.At C2 -- C3 a central and rightward broad-based disk protrusion in combination with significant ligamentum flavum hypertrophy results in moderate to severe central spinal stenosis which is new since prior exam. There is no distinct cord signal abnormality at this level.2.Diffuse myomalacia of cervical cord extending from C3 to C5 -- C6 disk level similar to prior exam.3.Stable post operative changes of anterior fusion of C3, C4 and C5 and posterior laminectomy without central spinal stenosis.4.Multilevel degenerative changes of cervical spine results in multilevel bilateral neural foraminal compromise (some significantly) as detailed. There is no significant change since prior study.