Degenerative Joint and Disc Disease with Traumatic Listhesis

Below are images from a 52 YO Female that presented after a MVA, referred by her primary care medical doctor for diagnosis and treatment.  The radiographs were ordered first and then the MRI.  My biggest concern was the central canal of the cervical spine which cannot be visualized on plain film.  I ordered the MRI specifically to view the central canal in light of the advanced degenerative changes in the cervial spine. 

NEUTRAL 

FLEXION 

 EXTENSION 

FINDINGS: [on MRI, BUT I use the radiographs to verify osteophytes and instability]

Reversal of normal cervical lordosis is noted on neutral sagittal imaging. There is a slight anterior spondylolisthesis of C4 over C5. Slight retrolisthesis of C5 over C6 and C6 over C7 is noted. Slight accentuation of anterior spondylolisthesis of C4 over C5 is noted on sagittal flexion imaging. No additional instability is demonstrated on sagittal extension imaging.There is no focal marrow replacement or marrow edema of the cervical vertebrae.Decreased disc height is noted at the C5-6 and C6-7 levels.The craniocervical junction is unremarkable.There is no focal abnormal signal or focal expansion of the cervical spinal cord. Minimal mucosal thickening is noted at the floor of the visualized portion of the right maxillary sinus compatible with chronic sinusitis pattern. 

C2-3: There is no central canal or foraminal stenosis. No significant intervertebral disc pathology is evident. 

C3-4: There is no central canal or foraminal stenosis. No significant intervertebral disc pathology is evident. 

C4-5: There is a slight anterior spondylolisthesis of C4 over C5. No significantcentral canal or foraminal stenosis is evident. No significant posterior disc protrusion is evident. 

C5-6: There is a slight retrolisthesis of C5 over C6. There is a broad-based central disc herniation of the protrusion type with posterior spurring with asymmetry to the right measuring approximately 3 mm in AP dimension which effaces the anterior/right anterior subarachnoid space. Mildto moderate degree of bilateral foraminal stenosis is noted greater on the right. 

C6-7: There is  slight retrolisthesis of C6 over C7. There is a broad-based central disc herniation of the protrusion type with posterior spurring measuring approximately 3 mm in AP dimension with asymmetry to the leftwhich partially effaces the anterior/left anterior subarachnoid space. Moderate degree of right-sided and moderate to severe degree of left-sidedforaminal stenosis isnoted. 

C7-T1: There isno central canal or foraminal stenosis. No significant intervertebral disc pathology is evident. 

No significant accentuation of intervertebral disc pathology is noted upon sagittal flexion and extension imaging.