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  • cttennan
    Participant
    Post count: 6

    Hello Dr. Corenman,

    I have been having back problems for a few years and it seems to be getting worse. My 1st MRI was done in July of 2018.
    Technique: Sagittal T2, sagittal T1, sagittal STIR, axial T2.

    There is a transitional lumbar sacral junction with partially
    sacralized right L5 vertebral body. Vertebral height is maintained.

    At L5/S1, no disc bulge or lateralizing disc herniation is present.

    At L4/L5, no disc bulge or lateralizing disc herniation is present.

    At L3/L4, there is mild disc space narrowing with small anterior
    marginal osteophyte formation. There is a small 1.2 cm in height by 5
    mm in AP by 5 mm in transverse dimension right subarticular inferior
    disc extrusion extending to the mid L4 vertebral body (series 6,
    images 7-8). Disc herniation causes mild narrowing of the right
    lateral recess with mild impingement of the subarticular right L4
    nerve root. Bulging disc causes minimal inferior foraminal
    encroachment.

    At L2/L3, there is disc desiccation with mild disc space narrowing and
    small anterior marginal osteophyte formation. Bulging disc causes
    minimal thecal impression and minimal inferior foraminal encroachment.

    At L1/L2, there is disc desiccation with tiny Schmorl’s nodes and tiny
    anterior marginal osteophyte formation. There is minimal posterior
    bulging of the annulus. No limiting central or foraminal stenosis is
    present.

    At T12/L1, there is disc desiccation. Small left paracentral disc
    protrusion causes mild thecal impression without neural impingement or
    limiting central stenosis.

    At T11/T12, there is a shallow central disc protrusion causing minimal
    thecal impression.

    The conus terminates at T12/L1 and is normal in signal and in caliber.

    Localizer images demonstrate an indeterminant 2.5 cm in height right
    lateral renal lesion possibly a renal cyst.

    IMPRESSION: MRI lumbar spine.
    1. Transitional lumbar sacral junction.
    2. Small right subarticular inferior disc extrusion at L3/L4 causes
    mild impingement of the subarticular right L4 nerve root coursing
    through the right lateral recess.
    3. Small left paracentral disc protrusion at T12/L1 and shallow
    central disc protrusion at T11/T12 cause minimal to mild thecal
    impression without neural impingement or limiting central stenosis.
    4. Indeterminant 2.5 cm right lateral renal lesion possibly a renal
    cyst. Correlation with patient’s outside abdominal imaging suggested.
    If none are available then renal ultrasound could be performed to
    confirm cystic nature.

    I had a L3/L5 laminectomy August 2018 and that fixed the issue of drop foot and leg pain. December 2018 I was involved in a work accident where I was struck from behind and received whiplash. I had a cervical, and lumbar MRI to see if there was any further damage done and there was not and significant change. The cervical showed the resulting report.

    From the skull base to T4 was imaged. There is mild cervical scoliotic
    positioning convex towards the right. Vertebral height is maintained.

    At C2/C3, minor left-sided uncovertebral joint hypertrophy is present
    without causing significant foraminal encroachment.

    At C3/C4, uncovertebral joint hypertrophy results in mild thecal
    impression and minimal left foraminal narrowing.

    At C4/C5, there is mild disc space narrowing with tiny anterior
    marginal osteophyte formation. There is a broad-based disc osteophyte
    complex effacing the ventral and dorsal subarachnoid space slightly
    deforming the ventral cord. The central canal is narrowed to an AP
    diameter of approximately 8.8 mm. Uncovertebral joint hypertrophy
    results in severe bilateral foraminal stenosis.

    At C5/C6, there is mild disc space narrowing with small anterior
    marginal osteophyte formation. There is a bulging disc with
    spondylitic ridging contacting the ventral cord. The central canal is
    minimally narrowed to an AP diameter of approximately 9.6 mm.
    Uncovertebral joint hypertrophy results in severe bilateral foraminal
    stenosis.

    At C6/C7, there is mild disc space narrowing with small anterior
    marginal osteophyte formation. Bulging disc causes mild thecal
    impression. Uncovertebral joint hypertrophy results in severe left
    foraminal stenosis.

    At C7/T1, bulging disc causes minimal thecal impression.

    At T1/T2, small right paracentral disc protrusion causes mild thecal
    impression without cord impingement.

    At T2-T3, shallow right paracentral disc protrusion causes minimal
    thecal impression.

    At T3/T4, bulging disc with spondylitic ridging contacts the ventral
    cord. The dorsal subarachnoid space is maintained.

    No intrinsic cord signal abnormality is identified. Cervical medullary
    junction appears unremarkable. Paraspinal soft tissues appear
    unremarkable.

    IMPRESSION:Noncontrast MRI cervical spine.
    1. Cervical scoliotic positioning convex towards the right.
    2. Mild cervical and proximal thoracic spondylosis.
    3. Small disc osteophyte complexes cause mild thecal impression with
    minimal to mild narrowing of the central canal at C4/C5 and at C5/C6.
    No evidence for underlying cord signal abnormality.
    4. Uncovertebral joint hypertrophy results in prominent bilateral
    foraminal stenosis at C4/C5, bilaterally at C5/C6 and on the left at
    C6/C7 with neural impingement.
    I did 8 weeks of PT and several months of Chiropractic which helped but I am still having cervical issues. Below is the 2nd cervical MRI report

    From the skull base to the mid T4 vertebral body was imaged. There is
    mild cervical scoliotic positioning convex towards the right.
    Vertebral height is maintained.

    At C2/C3, minor left-sided uncovertebral joint hypertrophy is present
    without causing significant foraminal encroachment.

    At C3/C4, there is a shallow left paracentral disc osteophyte complex
    contacting the ventral cord. The dorsal subarachnoid space is
    maintained. Uncovertebral joint hypertrophy results in minimal left
    foraminal narrowing, unchanged.

    At C4/C5, there is mild disc space narrowing, tiny Schmorl’s nodes and
    tiny anterior marginal osteophyte formation. There is a broad-based
    disc osteophyte complex effacing the ventral and dorsal subarachnoid
    space slightly deforming the ventral cord. The central canal is
    narrowed to an AP diameter of approximately 8.6 mm compared with 8.8
    mm, previously. Uncovertebral joint hypertrophy results in severe
    bilateral foraminal stenosis, unchanged.

    At C5/C6, there is mild disc space narrowing with small anterior
    marginal osteophyte formation. There is a broad-based disc osteophyte
    complex slightly eccentric towards the right contacting the ventral
    cord. The dorsal subarachnoid space is maintained. The central canal
    is minimally narrowed to an AP diameter of approximately 9.6 mm,
    unchanged. Uncovertebral joint hypertrophy results in severe bilateral
    foraminal stenosis, unchanged.

    At C6/C7, there is mild disc space narrowing with small anterior
    marginal osteophyte formation. Bulging disc causes mild thecal
    impression without cord impingement or limiting central stenosis.
    Uncovertebral joint hypertrophy results in severe left foraminal
    stenosis, unchanged.

    At C7/T1, bulging disc causes mild thecal impression.

    At T1/T2, small superior right paracentral disc extrusion causes mild
    thecal impression without cord impingement. Disc herniation has
    slightly increased in size when compared to previous examination.

    At T2/T3, shallow right paracentral disc protrusion causes minimal
    thecal impression, unchanged.

    At T3/T4, bulging disc with spondylitic ridging contacts the ventral
    cord. The dorsal subarachnoid space is maintained.

    No intrinsic cord signal abnormality is identified. Cervical medullary
    junction appears unremarkable. Paraspinal soft tissues appear
    unremarkable.

    IMPRESSION:Noncontrast MRI cervical spine.
    1. Mild cervical scoliotic positioning convex towards the right be
    secondary to muscular spasm or patient positioning.
    2. Stable cervical spondylosis with small disc osteophyte complexes
    causing minimal cord impingement and narrowing of the central canal at
    C4/C5 greater than than at C5/C6. Central canal stenosis has slightly
    increased at C4/C5. No evidence for underlying cord signal
    abnormality.
    3. Slight interval increase in size of right-sided disc herniation at
    T1/T2 causing mild thecal impression without cord impingement.
    4. Uncovertebral joint hypertrophy again results in multilevel
    prominent foraminal stenosis, unchanged.

    I have the follow up with the neurologist next month to discuss the next steps. I have been having headache’s with the pain throughout my neck, that runs into the left shoulder, and forearm. I have had numbness in the hand also. Along with dropping things, and problems picking up small items. I have also been experiencing some pain in my chest on the left side. My thoracic spine feels like it in constant spasm and the only position that I feel comfortable is on my back with my legs up. Can you please help me understand what is going on and your opinion on what the plan of care should be? I will be 48 years old next month and am good health other than my spine.

    Many thanks
    Craig

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You have to describe your symptoms to go along with the MRI findings and the surgeries. Also, how did the symptoms change after the surgeries? See these two symptom description instructions. https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/
    https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/

    Dr. Corenman

    cttennan
    Participant
    Post count: 6

    Update for MRI results. The original lumbar spine MRI was a result of severe hip, and calf pain that happened after carrying a large suitcase down a flight of stairs. It started with a cramp in my hip and started traveled into the side of my calf a few days later. After a week it became difficult to sit for any period of time. I did not have any back pain. I would get a shock like jolt when I would stand up or turn at the waist. I developed weakness in the right leg along with drop foot and it became more difficult to walk. I thought I was having a problem with my hip and had no idea it was my back causing the problems. The pain level was about an 8. I went to the chiropractor to get an adjustment. I explained my symptoms to the chiropractor and he tried to adjust me. As soon as he positioned me a had the electric shock pain shooting down the right side. I decided it was time to visit the orthopedic for further evaluation. The Dr. immediately recognized the symptoms and referred me for a MRI and neurologist follow up. 2 weeks later none of the symptoms changed and I went to my neurologist appointment and was immediately scheduled for surgery. I had nerve compression at L3/L4 that was causing the problems. After surgery I had instant relief of the pain and symptoms. that was August 2018.

    December 2018 my back felt better that it had in years. I was on a forklift at work moving some pallets and had stopped to let another forklift pull out of an aisle when I was struck from behind by another forklift. I immediately felt pain from my neck down to my tailbone. I was taken to the hospital for evaluation and a CT scan. The CT scan did not show any major trauma. For the next 2 weeks I was in a considerable amount of cervical and lumbar pain 8-10 when walking around and a 5-6 at rest. I started to lose sensation in my hands and had numbness in my fingers and thumb. The pain in the neck was dull aching pain with some shock pain when turning my head. I made an appointment with my surgeon for evaluation. I had some hyperflexia and tested positive for Hoffmans sign. I went for the 2nd MRI. After going over the results my surgeon said there was nothing that needed immediate surgical repair. I had several bulging disc without cord impingement. I was referred to PT and chiropractic care. I did the 8 weeks of PT and several months of Chiro care. The pain and numbness slowly got better but i never recovered completely. I still had numbness in my hands and electric shocks that ran down my arms. I was having stiff neck and mid back spasms daily. The pain was mainly dull and achy with some sharp pains 6-8. Over the past 3 months the intensity has increased and the duration has also increased. I noticed that I would drop thing from my left hand and my fingers were numb mainly in the pointer finger and thumb. It started to become difficult to sit at my desk and work and driving made me uncomfortable. The pain is a 6-8 and I would get relief when I would lay down. I went back to my surgeon for evaluation. I showed the same symptoms as before, hyperflexia and positive Hoffmans left and right. I have had the 2nd cervical MRI and am waiting to follow up with the surgeon March 3rd. As I am sitting here typing this my hands are becoming more numb and my thoracic spins is starting to ache more along with my neck.

    Please let me know if you need any more information to assist you with evaluation. I need to find somewhere to get horizontal for a few minutes. Thank you very much for your time and expertise. I greatly appreciate anything you can do to help me.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Cut and paste all imaging studies of your cervical, thoracic and lumbar spines here so we can dissect them.

    Dr. Corenman

    cttennan
    Participant
    Post count: 6

    Is there an easy to do that? The portal with my images do not let me copy and paste. I have to snip every image and save it to a folder. Do you have a way to send me a private message and I can give you access to my Shields MRI portal?

    cttennan
    Participant
    Post count: 6

    Is there an easy way to do that? The portal with my images do not let me copy and paste. I have to snip every image and save it to a folder. Can you send me a private message and I can give you access to my Shields MRI portal?

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