Right arm numbness and tingling. Back pain with worsening bowel incontinence, exquisitely tender lower back. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C4 on C5 and minimal of C5 on C6. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is mild retrolisthesis with disc osteophyte complex resulting in effacement of the ventral thecal sac and mild impression on the ventral cord. There is mild to moderate spinal canal stenosis at this level and mild bilateral neural foraminal stenosis.C5-6: Small disc osteophyte complex, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis..C6-7: Small disc osteophyte complex. There is mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina. Prominent right-sided facet arthropathyThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 not significant changed since 6/26/2008. There is also minimal L3 on L4 anterolisthesis also similar to prior. Bone marrow signal is heterogeneous without discrete suspicious lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy without neural foraminal stenosis. There is mild spinal canal narrowing which is worse in the interval.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.L4-L5: Disc uncovering and mild bulge with advanced bilateral facet arthropathy and prominent bilateral ligamentum flavum thickening. There is resulting mild spinal canal stenosis which appears slightly worse since 6/26/2008. The ligamentum flavum thickening partially effaces the posterior lateral aspects of the thecal sac. There is mild to moderate bilateral neural foraminal narrowing which is slightly worse in the interval.L5-S1: Severe loss of disc height, mild disc bulge and facet arthropathy are seen without significant spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis similar to prior. Paraspinous soft tissues are within normal limits. Renal cysts again seen
1. Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 level. There is mild neural foraminal narrowing on the right at the C4-C5 level and moderate neural foraminal narrowing on the right at the C5-C6 levels which may be impinging on the right C5 and C6 nerve roots. Individual levels as above.2. Multilevel degenerative changes in the lumbar spine which have slightly progressed since 6/26/2008. There is degenerative grade 1 anterolisthesis of L4 on L5. There is neural foraminal stenosis at L4-L5 and L5-S1 as detailed above. There is mild spinal canal stenosis at the L4-L5 level and to a lesser degree at the L2-L3 level. No high-grade spinal canal stenosis in the lumbar spine is appreciated.3. Advanced facet arthropathy at the L4-L5 level which may be contributing the patient's low back pain.