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  • Littleshell09
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    Post count: 7

    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
    Moderator
    Post count: 8465

    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).

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