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Future53 06-09-2012 09:37 AM

Thoracic - focal bulges - uncertain clinical significance

This is my original post and MRI from January of this year, Jennybyc was kind enough to answer my questions. I have now changed pain centers due to no doctors seeing me, only the PA with symptoms progressively getting worse. The new Spine/Surgical center sent me for Thoracic MRI, they believed I also have issues there.


[COLOR="Purple"]To start with, you have 2 major problems in your is the disks/bone spurs hitting your spinal cord and the other is the compression of the spinal nerves in your neck. It is the compression of the spinal nerves that causes all the pain...compression of your cord may not hurt at all but can cause other problems such as muscle dysfunction and numbness.

C3-4: there is moderate disc bulge in conjunction with bony spurring across midline and preferential to the right with mild right sided foraminal narrowing. This is new as compared to previous study.

You have a new problem here with compression by a bulging disk and arthritic bone spurs to a mild degree on the right sided spinal nerves. This should be causing pain in the area of your neck and shoulders.

C4-5: there is focal bulge in the midline effacing the anterior CSF space coming in contact with anterior aspect of cord causing deformity of the contour of cord anteriorly.

Here the same kind of bulging disk(as above)along with arthritis bone spurs(as above) are pushing backwards towards your spinal cord. It is actually touching the front side of your cord and they can see it actually deforming the oval shape of your cord. But no measurements are given as to how compressed your cord is so I assume it is normal size, just flattened.

C5-6: there is disc bulge and bony spurring effacing the anterior CSF space and deforming the cord in the midline, unchanged since prior study.

Exactly the same as the area above.

C6-7: this is disc bulge and bony spurring in the midline and preferential to the right which is similar to that seen previously. There is mild right sided neural foraminal narrowing.

At this level, you have the same issue with the cord but with no deformity seen. As with the first level sited, you have compression of the spinal nerves on the right side to a mild degree. This would be causing pain all the way down your arm into the middle, ring and pinky fingers.

LUMBAR - Moderate loss of disc space height at L4-5, which is seen in conjunction with posterior extension of disc material preferential to the left of midline with a contour most consistent with a relatively focal bulge. This deforms the anterior aspect of the thecal sac across the midline and preferential to the left.
Impressison, focal bulge preferential to the left at L4-5 with some deformity of the anterior aspect of the thecal sac at this level. This is seen in conjunction with a component of desiccation and moderate disc space narrowing.

You have a disk that is drying out and shrinking. It has herniated backwards and to the left toward your spinal cord and is touching the membrane(thecal sca) that covers the cord and holds the spinal fluid in around the cord.[/COLOR]


My MRI states I have 3 levels of focal bulges effacing the cord at T7-T8, T8-T9 AND T9-T10 effacing the cord with spurring. What I don't understand is, it also states immediately following this "uncertain clinical significance. Please see axial images #2, #10 and #16 respectively.


Thanks in advance

teteri66 06-09-2012 04:40 PM

Re: Thoracic - focal bulges - uncertain clinical significance
A MRI is one piece of the diagnostic puzzle. The doctor correlates the images of the MRI with what he finds upon physical examination, a basic neurologic exam, and listening carefully to the person's history, symptoms and complaints. Some images look like something is very serious, when in reality it causes no pain for the patient. Conversely something that looks OK on MRI can turn out to be causing a great deal of pain.

The writer is stating that it is not apparent if these results have any particular significance to what brought you in for the MRI in the first place...whether it is relevant to your complaints, symptoms, etc. The writer is indicating to the examining doctor that something is not quite normal, but it will be up to the examining doctor to determine if it is meaningful, or not. Then the writer tells the doctor which images to pay particular attention to....

jennybyc 06-10-2012 04:31 PM

Re: Thoracic - focal bulges - uncertain clinical significance
Teri is right on!(as usual).

I also have herniated disks at T6,7 and 8 but not too many symptoms...only get bad pain now and then but I do numb areas on my back...but I can take a numb back....but not numb hands......that is what makes the clinical difference. If I had the same problems in my hands and arms, I might need surgery but since I don't care if my back feels numb, they leave it alone.

So they cross check the MRI results not only with your symptoms but might do an EMG/NCS to test the nerves and see if they are affected and how badly. Might do other tests too.

As Teri's just one piece of the puzzle they look at. I just had lumbar surgery and the MRI and EMG/NCS showed mild problems but my symptoms showed severe problems. Once they got into my back, it turned out my symptoms were correct and the MRI did not show the whole problem.

Just part of the puzzle!


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