Differential Diagnosis
- Single most likely diagnosis
- Cervical Spondylosis: This diagnosis is the most likely due to the presence of advanced mid to upper cervical facet osteoarthropathy, reversal of the upper cervical lordosis, and multilevel signs of degenerative disc disease, including disc space narrowing and endplate osteophytic ridging. The patient's 18-year history of neck pain also supports this diagnosis.
- Other Likely diagnoses
- Cervical Spinal Stenosis: The presence of multilevel disc space narrowing and osteophytic ridging could lead to spinal stenosis, which may cause neck pain and other neurological symptoms.
- Degenerative Disc Disease: The findings of disc space narrowing and endplate osteophytic ridging at multiple levels (C3-4, C5-6, and C6-7) support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Atlantoaxial Subluxation: Although the atlantoaxial relationships appear anatomic, it is essential to consider this diagnosis due to the potential for serious neurological consequences if missed. However, the absence of significant anterolisthesis at the C1-C2 level and the maintenance of vertebral body stature make this less likely.
- Spinal Cord Compression: The presence of advanced facet osteoarthropathy and degenerative disc disease increases the risk of spinal cord compression, which could lead to serious neurological deficits if not addressed promptly.
- Rare diagnoses
- Rheumatoid Arthritis: Although less likely, rheumatoid arthritis could cause cervical spine instability and degenerative changes, particularly if the patient has a history of this condition.
- Ankylosing Spondylitis: This inflammatory condition could lead to cervical spine degeneration and instability, but it is less common and typically presents with other systemic symptoms.