• Moderately advanced degenerative change at the residual disc levels with very minor spondylolisthesis at C2/C3 and retrolisthesis at C3-C4. The central canal is well-decompressed with no complication seen at the 2 level ACDF. Multilevel disc bulges are evident most notable at C3/C4 where there is a degree of canal stenosis with loss of CSF around the cord in the neutral and extended positions and possible minor compression of the cord, but no definite increased cord signal intensity.
• AP canal dimension in neutral and extension is estimated at 5 mm compared to 7.5 mm in the flexed position. Central canal dimensions elsewhere are satisfactory. No abnormality is seen at the craniocervical junction or in the upper thoracic canal. There is fairly severe right-sided C3/C4 foraminal compromise with potential C4 compression, but the remaining foramina are reasonably well-preserved. Marrow signal is unremarkable and facet alignment is normal. No abnormality is seen in the pre-vertebral space.
• Conclusions: There is certainly reduction of the AP canal dimension due to a combination of disc bulging and ligamentous thickening at the C3/C4 level in the neutral/extended positions compared to the flexed position with mild compression of the cord but no evidence of myelomalacia.