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ke/bv/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzalmn / F / 68 yrs.
Referred by : Dr. Abc Xyztrak.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O neck pain radiating to the LUE.
H/O fall on 00.00.00.

EXAMINATION :

M.R.I of the cervical spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

OBSERVATION :

There is loss of normal cervical curvature with reduction in the C4-C5, C5-C6 and C6-C7 discs height. The cervical intervertebral discs show loss of water content.

There are posterior disc herniations at the C4-C5, C5-C6 and C6-C7 levels with large posterior peridiscal osteophytes. There is anterior indentation of the thecal sac with left neural foraminal narrowing. Slight indentation of the cord is noted at the C4-C5 and C5-C6 levels. The joints of Luschka on the left side at the C4-C5, C5-C6 and C6-C7 levels also show degenerative changes. There is also indentation upon the left C5, C6 and C7 nerve roots. Mild flavum hypertrophy is seen at the C5-C6 level.

There is anterior wedging of the C4 and C5 vertebral bodies with irregularity of the inferior cortical endplate of C4 and superior cortical endplate of C5. Type I and Type III degenerative changes are seen adjacent to the C4-C5 disc in the C4 and C5 vertebrae.



Small postero-central disc herniations are noted at the C2-C3 and C3-C4 levels with posterior peridiscal osteophytes.

Diffuse fatty changes are seen in the upper cervical vertebrae.

The rest of the cervical vertebral bodies show normal signal intensity. The remaining joints of Luschka and the visualized pre and paravertebral soft tissues are unremarkable.

The cervical spinal cord reveals normal signal intensity.

The atlanto-axial region and the cervico-medullary junction are unremarkable.

Small subcentimeter lymph nodes are seen deep to the sternomastoid muscles bilaterally.

IMPRESSION :

1. Posterior disc herniations at the C4-C5, C5-C6 and C6-C7 levels with large posterior peridiscal osteophytes.

2. Degenerative changes of the joints of Luschka on the left side at the C4-C5, C5-C6 and C6-C7 levels with indentation upon the left C5, C6 and C7 nerve roots.


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