[Stacy]

#34965

MRI OF THE CERVICAL SPINE WITHOUT CONTRAST:
HISTORY: Q07.03 ARNOLD CHIARI TYPE 1, compare to prior (3/25/2014) scan
TECHNIQUE: 1.5 tesla MRI of the cervical spine was performed with acquisition of routine sequences. Gadolinium was not administered.
COMPARISON: Cervical spine MRI performed on 11/5/2014 FINDINGS:
Again seen is evidence of a Chiari I malformation, with 0.9 cm herniation of inferiorly-angulating cerebellar tonsils below the level the foramen magnum. There is no significant effacement of the dorsal or ventral CSF cisterns of the cervicomedullary junction. The appearance has not changed from the prior study performed on 11/5/2014.
Evaluation of the cervical spinal cord demonstrates no signal abnormality. There is no evidence of cord expansion or volume loss. However, again partially covered on this exam is hydrosyringomyelia of the upper thoracic spinal cord, noted spanning roughly T3 through the T4-T5 level, which is the inferior margin of the exam. The thoracic cord

syrinx is incompletely covered however does not appear to have changed from the prior study performed in November 2014. There is no associated cord edema, expansion, or volume loss.
Again seen is evidence of ACDF performed at C5-C6. There appears to be mature osseous fusion of the involved vertebral levels, however please note that postoperative osseous anatomy and fixation hardware are poorly assessed by MRI and reference can be made to recently performed CT of the cervical spine from 12/13/2021 for further assessment.
Vertebral body heights are maintained. There is retrolisthesis of C4 on C5 over an approximate distance of 0.3 cm, a finding that is newly evident from the prior MRI performed on 11/5/2014. Alignment is otherwise maintained in the sagittal plane with straightening of the normal cervical lordotic curvature.
Marrow signal is notable for degenerative endplate changes within the C4 level, progressed from the prior exam. There is a typical-appearing intraosseous hemangioma at the T3 level, stable. There is diffuse desiccation of the cervical intervertebral discs, on a degenerative basis, stable.
Paraspinal tissues are unremarkable, with normal-appearing vertebral artery flow-voids.
There is no significant degenerative disc disease, spinal stenosis or foraminal compromise through the C4 level.
C4-C5: A junctional zone, there is a broad posterior disc osteophyte complex with bilateral uncovertebral joint hypertrophy and facet arthropathy. This results in a moderate spinal stenosis with minimal mass effect on the ventral surface of the cervical spinal cord. There is severe right and moderate to severe left neural foraminal narrowing. When compared to the prior study, the degenerative disease burden has progressed at this level.
C5-C6: A surgical level, there is no evidence of significant spinal stenosis or foraminal comp otherwise.
C6-C7: A junctional zone, there is a shallow broad posterior disc protrusion without significant spinal stenosis. There is moderate narrowing of both neural foramina. Findings at this level are similar to slightly progressed.
C7-T1: No significant disease.
IMPRESSION:

Chiari I malformation, with 0.9 cm herniation of inferiorly-negative layering cerebellar tonsils below the level of the foramen magnum. There is no significant effacement of the dorsal ventral CSF cisterns of the cervicomedullary junction and there is no evidence of cervical cord signal abnormality. Findings have not changed from the prior study performed on 11/5/2014.
Partial visualization of an upper thoracic spinal cord syrinx, also unchanged from the prior exam though not fully covered on this study.
Evidence of ACDF of C5 and C6. There is worsening junctional zone spondylosis at C4-C5, where there is a new retrolisthesis and there are degenerative changes that result in a moderate spinal stenosis with severe right and moderate to severe left neural foraminal narrowing. Correlation with clinical symptoms is suggested.
Similar to slightly worsened junctional zone disease at C6-C7, where there is no significant spinal stenosis however moderate narrowing of both neural foramina.

Pt here for EDX studies
In brief, there is no clear-cut electrophysiologic evidence of a cervical radiculopathy Please see scanned report for further details

I have chronic neck pain IN my neck as well as severely tight neck muscles. So upper back, shoulder pain as well. Tingling in my bicep area. Kind of I. Between the bicep and tricep. Had severe left wrist pain that ortho xrayed (SST arthritis) Wore a splint for a month. Developed numbness in thumb. Splint did not help wrist pain. Started taking glucosamine. X2 weeks, wrist pain improved. Thumb still numb and tingling in upper arm.
What should I be worried about? Is PT going to help all of this? I will not take opioids. Can’t take NSAIDs indefinitely-GERD, chronic gastritis.

[Donald Corenman, MD, DC]

#34966

You note chronic neck pain with radiation into shoulders. Your report states: “Marrow signal is notable for degenerative endplate changes within the C4 level, progressed from the prior exam…There is severe right and moderate to severe left neural foraminal narrowing”.
Also; “There is worsening junctional zone spondylosis at C4-C5, where there is a new retrolisthesis and there are degenerative changes”

It does not appear that your Chiari type I is significantly symptomatic so I would believe that C4-5 is causing a majority of symptoms. The way to test this is to get bilateral SNRBs at C4-5 and keep a pain diary. If your symptoms temporarily are eliminated, this is good evidence that a surgical intervention (ACDF or ADR) would be quite helpful.

See:
https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/
https://neckandback.com/treatments/diagnostic-therapeutic-neck/ and
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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