MRI OF THE CERVICAL SPINE WITHOUT CONTRAST
DATE OF STUDY: MM/DD/YYYY
INDICATION FOR STUDY: Severe right arm pain.
TECHNIQUE AND FINDINGS: Comparison is made with the earlier scan. Sagittal and axial images were obtained. The craniocervical junction is within normal limits. There is some reversal of the normal curvature centered at approximately C4-5. There are posterior osteophytes at C5-6. The spinal cord is normal in location and signal intensity. The patient was in a lot of pain, and the scan time was therefore decreased.
At C7-T1, there is no focal disc disease.
At C6-7, there is a combination of posterior osteophytes and disc bulge that has a right paramedian component, which slightly flattens the anterior CSF space. This has not changed compared to the prior study.
At C5-6, there is a disc bulge combined with some posterior osteophytes, which does causes some narrowing of that right neural foramina and slightly flattens the anterior CSF space. This has not particularly changed compared to the prior study either.
At C4-5, there is near obliteration of the anterior CSF space due to a combination of bone and disc. In addition, there is a central disc protrusion that extends inferior to the disc space and causes some concavity of the spinal canal suggestive of progression of the disc protrusion/herniation in this area.
At C3-4, there is a disc bulge that has a subtle central component, which slightly indents the anterior CSF space. This has not significantly changed either.
IMPRESSION:
1. At C4-5, the disc protrusion seen previously, that was small and central, appears to have progressed and does cause more mass effect on the anterior CSF space and causes some concavity of the spinal canal. This disc does extend slightly inferior to the disc space. There is some right neural foraminal narrowing due to a combination of bone and disc at this level.
2. The right neural foraminal narrowing at C5-6 due to a combination of bone and disc is stable.
3. At C3-4, the subtle central disc protrusion is not significantly changed.
4. At C6-7, the disc bulge that has a slight right paramedian protrusion combined with posterior osteophytes is also not changed.
CERVICAL SPINE MRI
DATE OF STUDY: MM/DD/YYYY
INDICATION FOR STUDY: Right neck pain.
TECHNIQUE AND FINDINGS: This examination is somewhat limited as the patient repeatedly needed to get up from the table for pain and it was restarted. It is felt adequate, however, for diagnosis.
The craniocervical junction is normal. The upper part of the cervical cord is not compressed. In the mid portion of the cervical cord, we do see significant bone and disc disease, which does compress the cervical cord in combination fashion and produces a relative stenosis. This is seen at C4-5, C5-6, and at C6-7.
At C3-4, we see a very small left-sided uncinate spurring, which minimally narrows the left neural foramen. The right neural foramen is widely patent, and the spinal canal is within normal limits.
At C4-5, we see some midline vertebral body spurring and a modest annular bulge. This, with some facet degenerative disease, does narrow the AP diameter moderately such that the CSF fluid around the cord is compressed, and the cord is moderately flattened. The AP diameter is less than 10 mm.
At C5-6, we see a central disc process and endplate spurring as well as bilateral uncinate spurring. The combination produces trilateral narrowing of the spinal canal and bilateral neural foraminal narrowing. Most of the disc disease is more central. It is moderate in nature only.
At C6-7, we see a very large midline and right recess disc herniation. This presents also with some facet hypertrophy and significantly obscures the right recess and right neural foramen. The left neural foramen is moderately narrowed due predominantly to bony disease. Two sets of axial films were attempted due to the patient’s movement. One was filtered and one was unfiltered. The unfiltered images do suggest that the nerve root may exit above the bony protuberance to the left. It may not be as definitely compromised, as we can clearly see the right recess and neural foramen.
At C7-T1, we see that the spinal canal now opens up to a more normal caliber once again. CSF surrounds the cord, which appears of normal size and dimension, and both the neural foramina appear patent.
IMPRESSION:
1. Large midline and right recess disc herniation at C6-7. This in combination with some endplate spurring and facet hypertrophy significantly compresses the right recess and neural foramen and minimally to moderately compresses some bony disease, the left neural foramen.
2. At both C5-6 and slightly less so at C4-5, we see flattening of the cord due predominantly to bony and mild disc disease and loss of the cerebrospinal fluid space producing a relative stenosis. At C5-6, the suggestion of bilateral neural foraminal narrowing is also present due again to a combination of predominantly bone but secondarily disc disease of an annular nature, and at C4-5, there is some minimal narrowing to the left present.
3. No cystic change is suggested within the cord at this time. Cannot rule out some edema, however, directly behind the areas of narrowing that was described above. The largest area of focal disc disease is to the right at C6-7, and this disc does appear to ascend cephalad behind the lower portion of the C6 vertebral body minimally.
