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Procedure(s):MR CERVICAL SPINE WO CONTRAST
Date of service: 12/4/2014 7:41 AM
Provided clinical information: 49 years, Male, "pain, numbness into
arms, history disc issue with nerve impingement."
Procedure and materials: Standard protocol.
Contrast: None.
Potential limitations: Patient motion artifact.
Comparison studies: None.
Observations:
Multilevel intervertebral disc space narrowing, uncovertebral
degenerative changes, posterior disc osteophyte complexes and facet
hypertrophy are present. Cervical lordosis is maintained. Mild
hyperintense STIR signal within the subcortical endplates at C5-C6 and C6-C7 likely represents remodeling. Facets appear well aligned and
there is no splaying of the spinous processes. Spinal cord demonstrate
normal homogeneous signal intensity throughout.
Prevertebral musculature, paraspinous musculature/ligamentous
complexes, submandibular/thyroid glands and overlying soft tissues
appear normal. Bilateral cervical chain lymph nodes demonstrate no
aggressive features. Brain parenchyma in the posterior fossa
demonstrates mild prominence of the cerebellar tonsils at the level of
the foramen magnum without ectopia.
Findings by level (normal denotes no high-grade spinal canal or
neuroforaminal narrowing):
C1-C2: Osteophytic spurring and degenerative soft tissue yields
flattening of the thecal sac anteriorly without significant spinal
canal narrowing.
C2-C3: Normal.
C3-C4: Uncovertebral degenerative changes and posterior disc
osteophyte complex yield mild spinal canal, moderate right and mild
left neuroforaminal narrowing.
C4-C5: Uncovertebral degenerative changes, posterior disc osteophyte
complex and facet hypertrophy yield mild spinal canal and bilateral
neuroforaminal narrowing.
C5-C6: Uncovertebral degenerative changes, posterior disc osteophyte
complex and facet hypertrophy yield moderate spinal canal, severe left
and moderate right neuroforaminal narrowing. There is displacement and
remodeling of the left cervical hemicord without abnormal spinal cord
signal. C6-C7: Uncovertebral degenerative changes and posterior disc
osteophyte complex yield mild spinal canal, moderate left and mild
right neuroforaminal narrowing. C7-T1: Normal.
IMPRESSION:
Multilevel degenerative changes as detailed with the most significant
level demonstrating moderate spinal canal, severe left and moderate
right neuroforaminal narrowing. There is displacement and compression
of the spinal cord without abnormal spinal cord signal.
Urgency: IMPORTANT. This report contains IMPORTANT results which
require clinical attention.
Recommendation: No specific imaging recommendation. |
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