Spinal Case of Dr Dorman

This 57 year old Sudanese businessman has intermittently had shoulder/neck pains over the years, then two weeks ago suddenly felt severe knife-like pain into the left medial scapular region. This has continued intermittently, and two days ago pain and numbness started in the medial side of the left upper extremity, in the elbow and forearm.

Physical examination shows head normal, neck range of motion nearly normal, no arm atrophy or fasiculations, all arm DTRs present. Left arm weakness 4-/5 in long finger flexors and finger adductors, 4/5 in APB, 4+/5 finger abductors and wrist flexors. Other muscles 5/5. Numbness, partial, to pinprick in medial elbow & forearm area on left, and one evanescent time in the tip of the left 5th digit. Legs completely normal.

EMG of the left arm showed virtually no active denervation, only irritability and trains, mainly in forearm and hand. NCT of arms: left median amplitudes 1-2mv, left ulnar 2-3mv, right median 8mv, right ulnar 6mv; F wave right ulnar all respond 29-31msec (180cm man), left ulnar F-wave unresponsive. Orthodromic median sensories no response, but antidromics 50mcv with 51M/sec conduction.

We did an MRI of the neck. At what level do you think pathology was seen?