Differential Diagnosis for CT Cervical Spine Showing Moderate to Advanced Cervical Spondylosis with Multilevel Significant Foraminal Stenosis

• Single Most Likely Diagnosis
  • Cervical Spondylotic Radiculopathy: This condition is characterized by nerve root compression due to degenerative changes in the cervical spine, which matches the description of multilevel significant foraminal stenosis. The symptoms would typically include neck pain, arm pain, and neurological deficits corresponding to the affected nerve roots.
• Other Likely Diagnoses
  • Cervical Spondylotic Myelopathy: This condition involves compression of the spinal cord itself, leading to symptoms such as gait disturbance, weakness, and sensory changes in the limbs. Given the advanced cervical spondylosis, there's a high likelihood of spinal cord involvement.
  • Herniated Cervical Disc: While the primary issue is foraminal stenosis, herniated discs can also cause or contribute to foraminal narrowing and nerve root compression, especially in the context of advanced spondylosis.
• Do Not Miss Diagnoses
  • Spinal Epidural Abscess: Although less common, an abscess in the spinal epidural space can cause rapid neurological deterioration and requires urgent intervention. Symptoms might include severe pain, fever, and progressive neurological deficits.
  • Spinal Cord Infarction: This is a rare but potentially devastating condition that could present with acute onset of neurological deficits. While less likely, it's crucial not to miss due to its severe implications.
• Rare Diagnoses
  • Rheumatoid Arthritis of the Cervical Spine: While more commonly associated with the hands and feet, rheumatoid arthritis can affect the cervical spine, leading to instability and stenosis. However, this would typically be accompanied by a known history of rheumatoid arthritis.
  • Osteochondroma: A type of benign bone tumor that can grow in the spine and cause foraminal stenosis. It's less common in the cervical region but should be considered in the differential diagnosis, especially in younger patients or those without a clear history of degenerative disease.