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  • thwebb80
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    Post count: 3

    I am in my late 30s and have dealt for ten years with intermittent mild/moderate mid-back pain. It has never fully resolved but has generally been effectively managed through exercise, stretching, massage, warmth, and pain killers.

    Every medical professional I’ve seen about it until recently has said an MRI is unnecessary given that I don’t have any symptoms beyond mild/moderate pain. In the past two months, however, I’ve been having intermittent numbness in my right foot. No weakness–I can still go to the gym, run, and ride a bike–but it at times feels somewhat numb. As a result, my GP referred for an MRI.

    The MRI findings, below, showed the what I now know is relatively unusual finding of two herniated discs in my thoracic spine, accompanied by diffuse DDD:

    FINDINGS: The bony alignment and marrow signal are normal. Loss of disc height and signal at all levels. Endplate Schmorl’s nodes herniation at multiple levels. The lesion in T11 vertebral body decreased on T1 with minimal central areas of increased signal intensity. This has vascular flow-voids of T2 and STIR-weighted images likely atypical hemangioma. Scattered typical hemangiomas present. The spinal cord is normal in size, shape and signal intensity.

    At the T5-T6 level, central to right paracentral disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

    At the T6-T7 level, minimal diffuse disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

    At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent.

    At the T9-T10 level, minimal diffuse disc bulge. Neuroforamina patent. Spinal canal is unremarkable.

    At the T11-T12 level, left paracentral disc herniation. The herniated material measures 1.4 cm inferior superior-inferior by 1 cm transverse by 0.4 cm AP This effaces the anterior CSF and impinges on the spinal cord. There is flattening of the left anterolateral aspect spinal cord at this level. Neuroforamina patent.

    At the T12-L1 level, small left paracentral disc protrusion.

    QUESTIONS:

    What is “flattening” and “impingement” of the spinal canal? Is this the same as spinal cord compression, or a different finding? Is the the likely cause of my numbness?

    Does a left paracentral herniation effect the left side of the body, and therefore would not be the cause of right foot numbness?

    Given my the findings and current symptoms, would surgery be an option, or is conservative treatment still recommended? I understand thoracic surgery is somewhat more complex that lumbar.

    thwebb80
    Participant
    Post count: 3

    For what it’s worth, here is my lower back MRI, which seems less remarkable other than to confirm that I have what you have described in other threads as Crappy Back Disease. Despite all the arthritis I have only mild problems with my lower back–occasional aches and pains, but nothing more.

    HISTORY: 37 year old male, script states: chronic back pain. Patient states: back pain for over 10 years with intermittent numbness in right foot.

    TECHNIQUE: Using a 1.5 Tesla magnet, multiplanar T1 and T2 weighted images were acquired.

    COMPARISON: None.

    FINDINGS: For the purposes of this dictation the lowest-most independent vertebra body is labeled as L5. The vertebral body heights are maintained. Disc heights are preserved. Endplate Schmorl’s nodes herniations at L1-2. The bone marrow is of normal signal intensity.

    Visualized lower thoracic levels and the conus medullaris: Normal.

    L1-L2: Minimal disc bulge. Facets appear unremarkable. Neuroforamina appear patent. Spinal canal appears unremarkable.

    L2-L3: No disc bulge or herniation. Facets appear unremarkable. Neuroforamina appear patent. Spinal canal appears unremarkable.

    L3-L4: No disc bulge or herniation. Moderate bilateral facet disease. Neuroforamina appear patent. Spinal canal appears unremarkable.

    L4-L5: Minimal disc bulge. Moderate bilateral facet disease. Neuroforamina appear patent. Spinal canal appears unremarkable.

    L5-S1: Minimal disc bulge. Severe bilateral facet disease. Neuroforamina appear patent.Spinal canal appears unremarkable.

    Visualized portion of the sacrum: Normal.

    Paravertebral/Prevertebral soft tissues: Normal.

    IMPRESSION:
    Minimal disc bulges L1-2, L4-5 and L5-S1. There is moderate to severe facet disease L3-4 and L5-S1 as detailed above. No disc herniations. Neuroforamina are patent. No central canal stenosis.

    thwebb80
    Participant
    Post count: 3

    And finally, the numbness seems to disappear when lying down, be negligible when standing (I use a sit/stand desk), and worsen with sitting.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Your MRI impression of our lumbar spine: “Minimal disc bulges L1-2, L4-5 and L5-S1. There is moderate to severe facet disease L3-4 and L5-S1 as detailed above. No disc herniations. Neuroforamina are patent. No central canal stenosis”.

    Your MRI summary of your thoracic spine is “At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent. and At the T8-T9 level, central disc herniation. The herniated material measures a 1.2 cm superior-inferior by 1.2 cm transverse by 0.6 cm AP. The herniation effaces the anterior CSF and impinges on and flattens anterior aspect spinal cord at this level. Neuroforamina patent”.

    Your lower back pain is probably generated by the degenerative discs and especially by the degenerative facet disease. The thoracic herniations could cause local thoracic pain which you do not complain of and can cause spinal cord compression symptoms such as imbalance, bowel and bladder malfunction and lack of coordination in your legs. If you don’t have those symptoms, these herniations can be simply watched.

    Dr. Corenman

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