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Old 06-23-2011, 11:25 PM   #1
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16 Disc Herniations???

Here are results for my 3 most recent MRI's: Cervical, Thoracic, and Lumbar:

Quote:
EXAM: MRI OF THE CERVICAL SPINE (performed Feb 2011).

CLINICAL INFORMATION: Neck pain with degenerative disc disease and prior cervical fusion. Comparison is made to 12/03/2007.

TECHNICAL INFORMATION: T1, T2 MPGR T2 FSE and STIR sagittal thin sections through the cervical spine with T2 gradient refocused and T2 FSE axial sections at selected levels.

INTERPRETATION: Craniovertebral junction structures are unremarkable and no fractures or active inflammatory lesions are identified on STIR images.

The cord is intrinsically normal without high signal alteration or mass lesion. Flow signals are noted in the vertebral arteries with no paraspinous mass lesions.

The C2-3 disc margin is normal and foramina appear patent. Facet joints appear within normal limits.

At C3-4, there is a 3 mm AP diameter central disc herniation indenting the ventral cord. Mild to moderate central stenosis. Foramina appear patent and facet joints are unremarkable.

At C4-5, the interbody fusion appears solid by MR criteria with no recurrent disc herniation or spinal stenosis.

At C5-6, disc degeneration is present with degenerative annular bulging and asymmetric right posterolateral 1.5 mm disc protrusion with overall mild central stenosis and mild ventral cord flattening. Foramina appear patent and facet joints are unremarkable.

C6-7 and C7-T1 levels are negative for disc herniation or stenosis.

At T1-2, the dorsal disc herniation indents the thecal sac centrally and to the right of midline.

CONCLUSION of Cervical exam:
1. A 3 mm AP diameter central C3-4 disc herniation indents and deforms the cord with mild to moderate central stenosis. Foramina appear patent.
2. Mild C5-6 spondylosis with dorsal annular bulging and concurrent 1.5 mm right disc protrusion with cord contact and mild central stenosis.
3. No recurrent C4-5 disc herniation or stenosis.
4. Intrinsically normal cervical spinal cord and craniovertebral junction.
5. Disc protrusion centrally into the right at T1-2.

Note: The C3-4 disc herniation has enlarged since 12/03/2007. Findings at C5-6 are unchanged.
**************************************** *****************

EXAM: OPEN UPRIGHT MRI OF THE THORACIC SPINE (Performed June 2011)
CLINICAL INFORMATION: Neck, diffuse back and left leg pain. Incontinence x 1 episode

TECHNICAL INFORMATION: Exam was performed on an 0.63T Open Upright MRI system. T1 and T2 FSE sagittal thin sections through the thoracic spine with T2 GRE and FSE axial sections at selected levels and the patient in the sitting 50° tilted position.

INTERPRETATION: Normal signal intensity is seen within the thoracic cord and conus medullaris. No intrinsic cord lesion and no cord edema or myelomalacia. No intradural mass.

Disc degeneration is seen at multiple levels throughout the thoracic spine with mild to moderate mid thoracic Scheuermann's-like changes, and 60° of kyphosis. Disc space narrowing is moderate or marked at each level from T11-12 through T2-3 with mild or moderate endplate irregularities at multiple levels.

At each level from L1-2 through T9-10, the dorsal disc margin and facet joints are normal. No stenosis or impingement.

At T8-9, a 2-3 mm broad-based right paracentral disc herniation is seen with ventral cord flattening. Normal facet joints and patent neural foramina.

At T7-8, a 2-3 mm cephalad extruded midline disc herniation is seen with mild ventral cord flattening. Normal facet joints and patent neural foramina.

At T6-7, a 4 mm extruded left paracentral disc herniation is seen with marked flattening of the ventral cord to the left of midline. Normal facet joints and patent neural foramina.

At T5-6, a 2 mm broad-based left posterolateral disc protrusion is seen without cord impingement. Normal facet joints and patent neural foramina.

At T4-5, moderate left posterolateral bulging and osteophyte is seen with normal facet joints and no stenosis or impingement.

At T3-4 and T2-3, lateral annular bulging is seen with moderate bilateral facet arthropathy at each level and patent neural foramina.

Anatomic detail is poor at T1-T2, C7-T1 and C6-7.

Normal signal intensity within the vertebral marrow spaces. No posterior mediastinal lymphadenopathy and no paraspinous mass.

CONCLUSION: Moderate to advanced diffuse thoracic disc degeneration with 61° of kyphosis with the patient sitting, and specific findings as follows:
1. 4 mm extruded left paracentral disc herniation at T6-7 with marked cord flattening on the left.
2. 2-3 mm midline disc herniation at T7-8 and 2-3 mm right paracentral disc herniation at T8-9 with mild ventral cord flattening at each level.
3. 2 mm broad-based left posterolateral disc protrusion at T5-6, and left posterolateral bulging/osteophyte at T4-5 without cord or nerve root impingement.
4. No intrinsic cord lesion and no intradural mass.
5. No neoplasm, fracture or infection.

**************************************** **********


EXAM: OPEN UPRIGHT MRI OF THE LUMBAR SPINE WITH FLEXION AND EXTENSION (performed June 2011)
CLINICAL INFORMATION: Neck, back, and left leg pain with weakness. Bladder incontinence x1. Evaluate for cord impingement.

TECHNICAL INFORMATION: On a 0.63T Open Upright MRI system, T1 and T2 FSE sagittal thin sections were obtained with T1 and T2 axial sections at selected levels and the patient in the sitting neutral position. T2-weighted sagittal and axial images were repeated with the patient extended and T2-weighted sagittal sections with the patient flexed.

INTERPRETATION: Five lumbar-type vertebrae are seen with a generalized lumbar hyperlordosis, 33° from T12 to S1 on flexion/extension, and no abnormal intersegmental motion. No spondylolysis or spondylolisthesis. Limited sections through the sacrum are unremarkable.

L5-S1: Moderate disc degeneration with a 3 mm midline disc protrusion, normal facet joints, and no stenosis or impingement.

L4-5: Moderate disc degeneration with a 2 mm left posterolateral disc protrusion, dorsal annular bulging, mild to moderate narrowing of the subarticular recesses, and encroachment on the traversing L5 nerve roots. There is mild narrowing of the central canal, and moderate narrowing of the right neural foramen on extension.

L3-4 through T12-L1: Normal intervertebral disc and facet joints with no stenosis or impingement.

T11-12 through T8-9: Moderate disc degeneration and mild dorsal bulging at each level without significant narrowing of the central canal. Normal facet joints and patent neural foramina.

Normal signal intensity is seen within the distal thoracic cord and conus medullaris. No intradural mass and no arachnoidal adhesions.

Normal signal intensity is seen within the vertebral marrow spaces. No retroperitoneal lymphadenopathy and no paraspinous mass.

CONCLUSION: Generalized lumbar hyperlordosis with 33° of flexion/extension, no segmental instability, and specific findings as follows:
1. Moderate L5-S1 disc degeneration with a 3 mm midline disc protrusion.
2. Moderate L4-5 disc degeneration with a 2 mm left posterolateral disc protrusion, mild to moderate narrowing of the subarticular recesses left greater than right, and dynamic narrowing of the central canal and neural foramen on extension.
3. Moderate multilevel lower thoracic disc degeneration with no stenosis or impingement.
4. No intradural lesion and no neoplasm, fracture or infection.
5. Comparison with previous MRI dated 12/03/2007 shows progressive disc degeneration at L4-5. A disc herniation previously seen on the left at L4-5 has decreased in size in the interval and the disc herniation noted on the current examination may represent residual disease.
I've had back and neck pain for years. Every MRI I have gotten over the years I have had to beg a doctor to order for me. I've had lumbar and cervical studies in the past that have shown degenerative changes, osteophytes, and severe cervical stenosis that resulted in a C4-5 ACDF in Nov 2006. I have a new pain doctor and he agreed with me that updated MRI's that would include my previously unexamined thoracic region would be a good idea, so he proceeded to order the needed studies. Now that I finally have recent mri's done of all of the major regions and it shows extensive disc involvement, I 'm even more mixed up than I started. I only got to talk to the doctor for a few minutes after getting the results. He felt that I have some serious disease at many levels, and he was particularly concerned about level T6-7. He felt there was significant stenosis present there, and he felt that level was inoperable. He seemed to think I was at high risk of mobility issues someday due to the disease present at that level.

I'm curious, does anyone have this extensive # of affected discs? If so, what sort of treatment was pursued to help you live with your symptoms and disease? what worked, and what didn't work? Please advise
__________________
Ehlers-Danlos Syndrome Type 3
Scheuermann's Kyphosis
Severe DDD with multiple herniations and areas of stenosis, 16 affected disks!
C4-5 ACDF 2006
C3-6 ACDF 2013
Chronic Myofaschial Pain Syndrome

Last edited by Laenini; 06-25-2011 at 06:57 AM.

 
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