• Cervical lordosis is preserved. No low-lying cerebellar tonsil. Atlantoaxial alignment is normal. Widespread disc degenerative changes with severe disc height loss at C5-6 and C6-7.
• Minor disc bulge at C2-3 level causes minor flattening of the ventral theca which is slightly more pronounced in extension and minimally improved with CSF signal seen ventral to the cord in the flexion position.
• At C3-4, a circumferential disc bulge with focal central disc protrusional element flattens the ventral cord and reduces AP canal dimensions to 5 mm which again is more pronounced in extension and slightly improved in flexion. There is minor right-sided disc osteophyte complex at this level.
• At C4-5, a large right-sided disc protrusion with some intrinsic hyperintense signal suggests annular tear/granulation tissue that significantly flattens the right side of the cord with associated intrinsic hyperintense cord signal. This is probably slightly worsened in both flexion and extension positions. Disc osteophyte complex on the right causes severe right-sided foraminal narrowing and likely compresses the exiting right C5 nerve root which is somewhat similar in flexion-extension positions.
• At C5-6, a circumferential disc bulge indents the ventral theca which is slightly worse in flexion and extension similarly. Minor right-sided foraminal narrowing and at least moderate left-sided foraminal narrowing from disc osteophyte complexes which appears minimally worsened in the flexion and extension positions.
• At C6-7, a circumferential disc bulge with more focal left paracentral component minimally indents the left side of the cord without intrinsic signal abnormality. Mild left foraminal narrowing. This appears unchanged in flexion and extension positions.
• Impression: Extensive mid cervical disc degenerative changes with most severe central canal compromise at the C4-5 level with interval new intrinsic cord signal abnormality in keeping with myelopathy. Dynamic minor worsening predominantly in extension position.