Dr. Corenman,
After several rounds of facet joints injections, constant NSAIDS and muscle relaxers, my symptoms in my original post have persisted. (thoracic/paraspinal and trapezius pain/spasms – upper/mid/lower trapezius and paraspinals. No lumbar pain). I am now 10 months out from the ACDF.
I was sent back for a C and T MRI. The results are as follows:
C spine:
Findings: Lower posterior fossa is normal. Craniocervical junction is intact. There is straightened cervical spine lordosis with preserved alignment, normal marrow signal, and no prevertebral soft tissue swelling. There has been interval anterior cervical discectomy and fusion C4-C6 and C5-C6 with apparent osseous integration of the intervening bone graft material.
C2-C3: No abnormality.
C3-C4: Minimal right uncovertebral hypertrophy. No disc protrusion or mass effect.
C4-C5: Canal is decompressed status post fusion and discectomy.
C5-C6: Canal is decompressed status post discectomy and fusion. Recesses and foramina are patent.
C6-C7: Very subtle and minimal less than 1 mm grade retrolisthesis C6 on C7 without disc protrusion or mass effect
C7-T1: No abnormality
The cervical spinal cord demonstrates normal caliber and signal without syrinx. There is no abnormal enhancement or mass.
Impression:
1. Status post ACDF C4-C6 with decompressed canal, recesses, and foramina.
2. No new disc protrusion or mass effect upon the canal.
3. Cervical spinal cord demonstrates normal caliber and signal with syrinx or abnormal enhancement.
T spine:
Findings: The thoracic vertebral bodies are aligned with normal marrow signal. There is very mild exaggeration of thoracic kyphosis. Paraspinal tissues are intact.
There is nonacute endplate Schmorl’s node T7-T8 with small central disc protrusion without mass effect. Disc dessication with loss of height T8-T9 with mild posterior endplate degeneration and small central disc protrusion without mass effect. Small central disc bulge T10-T11 without mass effect.
Cord terminates at T12. The thoracic spinal cord demonstrates normal signal and caliber w/o syrinx.
Impression:
1. Small disc protrusions mid and lower thoracic spine w/o mass effect.
2. Thoracic spinal cord is normal
As a healthy (except for this) 28 year old, it seems concerning my spine is falling apart. To the layman (me), it seems like my neck fusion was successful, and now my thoracic has some issues. The Schmorl’s node mentioned at T7-T8 is I believe right about where my pain is worst(lower between my shoulder blades). The T8-T9 dessication I knew about from a MRI 2 years ago, although that was the only issue and was causing me no pain at the time.
Although the MRI mentions no mass effect, if I was your patient what would be your recommended course of action? I would certainly prefer a conservative approach of course. Much thanks.