• There is loss of the normal cervical lordosis with antero-superior wedging of the C4 vertebral body. There is a mild retrolisthesis of C4 over C5 with reduced disc space height. There is pronounced central cord compression and stenosis at C4/C5 with hyperintense myelopathic signal change, resulting in the characteristic ‘snake eyes,’ sign. This is associated with a syrinx from the C2/C3 disc-C5/C6 disc, with further surrounding oedema like signal extending from mid C2-mid C7. There is a suggestion of focal low signal at the epicentre of the cord, immediately posterior to the C4/C5 disc but no convincing lesion is seen. However, given the amount of or cord oedema it is difficult to fully exclude a lesion here.
• There is compression of the C5 nerve roots bilaterally, right > left. There is further right C6 foraminal narrowing with no overt nerve compression. On the right paracentral aspect of C4/C5, there is a 7.5mm lesion which is likely a disc extrusion in the right far lateral aspect.
• Conclusion: Prominent C4/C5 myelomalacia with severe central stenosis and surrounding syrinx. Compression of the bilateral C5 nerve roots.