Name of the Patient : Abc Xyzhar Blmn / M / 71 yrs.
Referred by : Dr. Abc Xyzwhale.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O paresthesias in the little and ring finger of both hands since January 0000.
EXAMINATION :
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
OBSERVATION :
There is scoliosis of the cervical spine with convexity to the right. Slight retroplacement of the C5 over C6 vertebra is noted. There is reduction in height and loss of water content of the cervical intervertebral discs.
There is continuous ossification of the posterior longitudinal ligament at the C2 and C3 vertebral levels.
A postero-central protruded disc with peridiscal osteophytes is noted at the C2-C3 level indenting the dural theca anteriorly.
There is a fairly large left postero-lateral disc bulge with peridiscal osteophytes at the C3-C4 level with left neural foraminal narrowing and indentation on the traversing left C4 nerve root. Mild indentation on the cervical spinal cord at that level is also noted.
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A small posterior disc bulge with peridiscal osteophytes is noted at the C4-C5 level.
Small posterior disc herniation with peridiscal osteophytes is noted at the C5-C6 level. A left far lateral disc bulge is also noted at this level with left neural foraminal narrowing.
Slight ligamentum flavum hypertrophy is noted at the C3-C4 and C5-C6 levels.
Degenerative changes of the joints of Luschka on the left is noted at the C3-C4 and C5-C6 levels and on the right at the C6-C7 level. Hypertrophic facetal arthropathy is noted on the left at the C3-C4, C4-C5 and C5-C6 levels.
The upper cervical vertebral bodies show spotty farry marrow changes. Slight anterior wedging of C4 and C5 vertebral body is noted. Anterior peridiscal osteophytes are noted in the cervical region.
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.
IMPRESSION :
1. Scoliosis of the cervical spine with convexity to the right and slight retroplacement of the C5 over C6 vertebra.
2. Continuous ossification of the posterior longitudinal ligament at the C2 and C3 vertebral levels.
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3. A postero-central protruded disc with peridiscal osteophytes at the C2-C3 level.
4. A fairly large left postero-lateral disc bulge with peridiscal osteophytes at the C3-C4 level with left neural foraminal narrowing and indentation on the traversing left C4 nerve root.
5. A small posterior disc bulge with peridiscal osteophytes at the C4-C5 level.
6. Small posterior disc herniation with peridiscal osteophytes at the C5-C6 level.
7. Slight ligamentum flavum hypertrophy at the C3-C4 and C5-C6 levels.
8. Degenerative changes of the joints of Luschka on the left at the C3-C4 and C5-C6 levels and on the right at the C6-C7 level.
9. Hypertrophic facetal arthropathy on the left at the C3-C4, C4-C5 and C5-C6 levels.