[cindy2836]

#32556

MRI Thoracic Spine Without Contrast – Details
About This Test
Details
Study result
Impression
1. Moderate right foraminal stenosis at the T5-6 level.
2. No significant spinal canal stenosis at any level. There is scattered degenerative disc disease.
3. Stable bone marrow edema in the endplates anteriorly at the T8-9 level.

Narrative
PROCEDURE: MRI THORACIC SPINE WO CONTRAST

CLINICAL INFORMATION: Postural kyphosis of thoracic region, Displacement of thoracic intervertebral disc without myelopathy. Cervical spine fusion. Lumbar fusion. Pain across her bra line into the right anterior rib cage.

COMPARISON: Thoracic spine MRI 3/29/2019.

TECHNIQUE: Sagittal T1, T2 and STIR sequences were obtained through the thoracic spine. Axial T2-weighted images were obtained through the discs.

FINDINGS:

The thoracic vertebral bodies are normally aligned. There are no compression fractures. There is persistent degenerative marrow edema anteriorly at the T8-9 level. There is disc desiccation throughout. There is fusion of the lower thoracic/lumbar
spine. Pedicles screws begin at the T10 level.

The thoracic spinal cord is of normal caliber and signal intensity. There are no abnormalities within the spinal canal.

On the axial images, there is a shallow left central disc protrusion at the T7-8 level. This does not contribute to spinal canal stenosis. There is a mild diffuse disc bulge at the T8-9 level. There is no significant spinal canal stenosis.

There is a central disc protrusion at the T9-10 level. This is the level above the fusion. There is minimal spinal canal stenosis.

There is moderate right-sided foraminal stenosis at the T5-6 level. No other foraminal stenosis is noted.

There are no suspicious findings in the paraspinal soft tissues.

There is surgical fusion seen in the cervical spine on the localizer image. There is a small

[Donald Corenman, MD, DC]

#32565

MRIs don’t live in a vacuum. I need to know why you had the MRI performed. There is a clue (“Pain across her bra line into the right anterior rib cage” in the report above), but you have had fusions of the cervical and lumbar spines. What symptoms were you having before these procedures, how did these symptoms change and what symptoms are you having now?

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.

[cindy2836]

#32567

Yes Doctor I will list my history:
2013 pain down left leg from buttocks to back of heal did not improve with PT or epidural shot. Surgery was a posterior decompressive lam I believe at L5/S1
2015 same pain returned. First posterior fusion of that area
2018 same pain returned. Revised fusion, old hardware removed, Posterior fusion now extended S1-T10
within the first 9 months post op of that I developed pain in my mid back where I never had pain. Back to ortho-surgeon which his PA ordered both lumbar and thoracic CT scans which showed nothing. I complained to ortho, he advised me to stop working asap or something was going to break and I would end up in a wheel chair and need a machine to breath! Scared me but not retirement age yet so got a second ortho-neuro opinion with MRI March 2019 of thoracic and he said I could work and if anything broke they would fix it. The original surgeon just said to take ibuproffin 600mg for the pain. which I did and still painful. Altered my work schedule, rested more by missing out on fun outing with family and friends. Finally this pain in my mid back was now radiating around my right side along my rib bottom into my sternum/chest wall and most painful into my abdomen! Back to ortho which means his PA sees me and she tells me to see a PM doctor. That’s where I am at and considering radio frequency nerve ablation at the two levels above the fusion end at T10. I knew my thoracic MRI was now a year old so I made the Ortho PA order a new one as the PA asked me what I wanted and I told him to be rid of the pain I have lived with for 1 1/2 years oh which I forgot to add that about Nov 2019 I started with waking up with both arms but mostly right numb from should to hand. Then severe aching in right arm. I saw my GP who thought pinched nerve in neck and GP ordered cervical MRI then said see ortho. So I return to the same ortho who had done the previous 3 surgeries and saw him on Jan 7th and he was doing the ACDF C3-C7 ten days later. That was a cake walk recovery compared to my previous fusions. I feel since my first diagnose of DDD and spinal stenosis at age 59 here I am 7 years late at now 66 and thoracic problems. I always did the bone density test when my GP advised to and last year was now given diagnose of osteoporosis and osteopenia which I have had one Prolio injection just in March and will do again in 6 months. Yes I’m not a small build 5ft2in about 170. I’m active. Walk everyday if the pain allows. Now retired since Jan and I had planned on working until 70 but the pain was too much! Can you give me an idea of what I need to do?? Thank you!!

[Donald Corenman, MD, DC]

#32569

I am somewhat confused. You note first a decompression at one level (L5-S1) then a fusion I would imagine due to recurrent herniation or collapse. 3 years later, a pseudoarthrosis was noted???? (“revised fusion”) and now the fusion extends to T10??? Why? Did you have a degenerative scoliosis that was getting worse?

Then “within the first 9 months post op of that I developed pain in my mid back where I never had pain”. This can occasionally happen spontaneously above a 7 level lumbar fusion but possibilities of adjacent segment breakdown, increased thoracic kyphosis or surgical mal-alignment are possibilities too.

Diagnostic blocks should be considered before ablations are considered. These might include selective nerve root blocks or facet blocks.

A 4 level cervical fusion sounds like it was helpful to you. Would you agree? What was the surgery for?

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.

[cindy2836]

#32571

Thank you for your reply Doctor. No I did not have scoliosis. My ortho surgeon took it that high due to stenosis and DDD. My pain management doctor performed one brachial block diagnostic on March 10th and I had another scheduled the following week as the doctor said insurance requires he does two of them and the Covid cancelled out that out patient. So with the new thoracic MRI, you don’t think that a minimally invasive surgery to clean up the T 5-6 which may be pinching a nerve thus my radiating to the front rib/abdomen pain?? I have noticed every time a MRI of my spine has the words stenosis that my ortho surgeon recommends surgery. Yes the ACDF 4 level got rid of my right arm pain and numbness. The cervical MRI had stated stenosis. May I ask you please. Since I have two fusions now. S1-T10 and C3-C7, can a thoracic fusion be added without having to remove that hardware and make it one continuous rod??? Can one be proactive here since new MRI said disc dessigrated so I assume as I age will only get more painful? No mention of kyphosis in the MRI???

[cindy2836]

#32693

Hello Doctor, I did have an epidural steroid injection May 28th. It did take the fairly normal time frame of a week to feel the pain relief benefit. This was done in to my thoracic 5-6 due to the forarmanal stenosis and my complaint of radiating to the front rib pain and down into my abdomen pain. Well, that pain relief only lasted two weeks for me. I have a follow up visit with my Lima OH ortho surgeon next week. This pain mid back and radiating never lets up and is limiting my daily activities. I’m not sure my surgeon operates in the thoracic spine or not. From everything I read, it’s like no one wants to operate in the thoracic region of the spine? Do you do mostly min invasive or posterior big open surgeries? I’ve read about VATS? Anterior entry and rib removal? I can’t imagine living my life with this pain so I’m actually wanting surgery if that will resolve what seems to be a pinched nerve root at T 5-6.The doctor who performed the ESI said the stenosis was severe. It was diagnostic also as I had been about a level 7 pain and because of the numbing he injected with the steroid I immediately went to no pain!

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