[Littleshell09]

#7946

I saw a neuro today d/t spinal pain, often severe, accompanying paresthesia RLE, confirmed nerve damage EMG. Recent change is the bilateral leg pain when walking upstairs. He checked plantar/Babinski reflexes which were absent bilaterally. If you’d be so kind to look at the written reports accompanying my CTs/MRIs of my spine I’d feel grateful!
I’ll be as concise as possible. All studies without contrast.
MRI:
C-spine: straightening of normal cervical lordosis, fusion C5-6 vertebral bodies *(actually was C5-7)* fusion completely fused w/no visible residual disc material; Severe disc space narrowing C6-7. Moderate disc space narrowing T1-T2, T2-T3, T3-T4 & T4-T5 in visualized upper thoracic region.
C2-C3, C3-C4, C4-C5 show no focal protrusion, central stenosis. Neural foramen widely patent.
T1-T2 show minor disc bulging, no significant protrusion or central stenosis. Little disc bulging T2-T3 & T3-T4, but no significant canal narrowing is seen. Levels scanned in sagittal projection only. Spinal cord normal in course, caliber & signal intensity.

Thoracic MRI: Mild dextroscoliosis. Vertebral bodies normal in height. Disc space narrowing at most levels. Most severe T1&T2 and T6-T7. C5-6 fusion at margin of study. Small central canal protrusion at T7-T8, slightly flattens ventral cord, but there remains significant CSF posterior to cord, so significance is unclear. Also appears to be little protrusion at T3-T4 in upper aspect of study w/o central canal narrowing.

Lumbar MRI: vertebral body heights maintained. Slight anterolisthesis L4-L5, alignment otherwise maintained. Tiny Schmorl’s nodes at endplate of L4, inferior endplate L2, superior endplate T-11; mild desiccation of L2-3, thru L4-5 intervertebral discs with slight decrease of disc height most prominent L4-5. Round area of increased signal intensity in L side of L4 vertebral body consistent w/small hemangioma. There may also be a more subtle one at T-11. Conus medullaris terminates at T12-L1. No disc herniation, bulge, spinal canal stenosis or neural foramina stenosis.
At L4-L5 there is a slight anterolisthesis with an uncovered disc. There is severe facet hypertrophy, there is thickened ligamentum flavum, there is slight impression on the thecal sac w/o significant spinal canal stenosis. There is narrowing at the origin of the left neural foramina. Right is patent. Facet hypertrophy at L5-S1.

CT cervical: abbreviated version as they were looking at lymphadenopathy.
Few mm of anterior positioning on C4-C5. Cervical fusion C5-6-7, appears intact. There is a little bit posterior element degenerative change.
CT of thoracic area again to r/o generalized lymphadenopathy showed what was believed to be a bone island on thoracic vertebrae.
Sorry this is so long but I’m trying to find out what can be done to manage s/o pain, paresthesias, pain & weakness in BUEs & BLEs. And to see if my sx are at all justified based in findings noted here. Thank you.

[Donald Corenman, MD, DC]

#8437

You have multilevel degenerative changes in your cervical, thoracic and lumbar spines. You have had a previous ACDF fusion at C5-7. There is some concern that the C6-7 level did not fuse as the x-ray reading notes “Severe disc space narrowing C6-7” when it should read; “fusion C5-7 (not C5-6) vertebral bodies, fusion completely fused w/no visible residual disc material. A pseudoarthrosis (lack of fusion) could be causing your neck pain at this level but other degenerative levels could also be causing pain.

Nonetheless, the CT scan was read as a solid fusion of C5-7 but this scan might not have had the care taken for reading a solid fusion as it was performed for lymphadenopathy and not for fusion.

You have a degenerative spondylolisthesis of L4-5 as read by the radiologist (but not identified); “Slight anterolisthesis L4-L5” and “There is severe facet hypertrophy, there is thickened ligamentum flavum”. One of the questions is if this level is unstable. This would require X-rays including flexion/extension views. Instability could cause lower back pain, an instability pattern (see website for description) and neurogenic claudication (again-on website).

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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