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What Does This MRI Report Indicate?
Question: I am being referred to a neurosurgeon for consultation because of the results of MRI of the cervical spine. I see him tomorrow, but don't know what kinds of questions to ask of him. The report I received noted a number of things but the one that I can't understand is:
C3-4: Slight dorsal angulated kyphosis and slight forward slippage. Posterior broad shallow disc bulge slightly deforming the anterior surface of the spinal cord. Mild narrowing of the central spinal canal. Central spinal canal measures 8 to 9 mm in the midline sagittal dimension. Mild right-sided foraminal narrowing. No significant narrowing of the left neural foramen.
C4-5: Slight retrolisthesis and posterior broad disc bulge slightly deforming the anterior surface of the spinal cord and resulting in mild to moderate narrowing of the central spinal canal. The central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Mild to moderate right-sided foraminal narrowing related to slight retrolisthesis, thickening of the right uncovertebral joints, bulging of the cervical disc, and severe narrowing the cervical disc space. Subchondral degenerative marrow signal change.
C5-6 Posterior broad disc bulge and slight infolding of the ligamentum flavum contributing to mild to moderate narrowing of the central spinal canal. Central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Moderate to severe bilateral foraminal narrowing related to thickening of the uncovertebral joints, bulging the cervical disc and narrowing of the cervical disc space.
C6-7: Posterior broad disc bulge and slight infolding of the ligamentum flavum contributing to mild to moderate narrowing of the central spinal canal. Central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Severe right sided and mild left-sided, bilateral foraminal narrowing related to thickening of the uncovertebral joints, bulging of the cervical disc, narrowing the cervical disc space.
C7-T!: Posterior disc bulge impressing upon thecal sac and infolding of the ligamentum flavum contributing to a mild narrowing of the central spinal canal. Central spinal canal measures 8 to 9 mm in the midline sagittal dimension. No significant narrowing of the neural foramina.
I vaguely understand some of the sentences, but I am not familiar enough to ask intelligent questions. Is there anything in this information that should cause me such alarm that I should be consulting a surgeon?
C3-4: Slight dorsal angulated kyphosis and slight forward slippage. Posterior broad shallow disc bulge slightly deforming the anterior surface of the spinal cord. Mild narrowing of the central spinal canal. Central spinal canal measures 8 to 9 mm in the midline sagittal dimension. Mild right-sided foraminal narrowing. No significant narrowing of the left neural foramen.
C4-5: Slight retrolisthesis and posterior broad disc bulge slightly deforming the anterior surface of the spinal cord and resulting in mild to moderate narrowing of the central spinal canal. The central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Mild to moderate right-sided foraminal narrowing related to slight retrolisthesis, thickening of the right uncovertebral joints, bulging of the cervical disc, and severe narrowing the cervical disc space. Subchondral degenerative marrow signal change.
C5-6 Posterior broad disc bulge and slight infolding of the ligamentum flavum contributing to mild to moderate narrowing of the central spinal canal. Central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Moderate to severe bilateral foraminal narrowing related to thickening of the uncovertebral joints, bulging the cervical disc and narrowing of the cervical disc space.
C6-7: Posterior broad disc bulge and slight infolding of the ligamentum flavum contributing to mild to moderate narrowing of the central spinal canal. Central spinal canal measures 7 to 8 mm in the midline sagittal dimension. Severe right sided and mild left-sided, bilateral foraminal narrowing related to thickening of the uncovertebral joints, bulging of the cervical disc, narrowing the cervical disc space.
C7-T!: Posterior disc bulge impressing upon thecal sac and infolding of the ligamentum flavum contributing to a mild narrowing of the central spinal canal. Central spinal canal measures 8 to 9 mm in the midline sagittal dimension. No significant narrowing of the neural foramina.
I vaguely understand some of the sentences, but I am not familiar enough to ask intelligent questions. Is there anything in this information that should cause me such alarm that I should be consulting a surgeon?
Brief Answer:
Read below
Detailed Answer:
I read your question and the MRI report carefully and I understand your concern.
That MRI report shows diffuse degenerative changes of the spine. These changes have happened over many years due to the wear and tear of the spine with time. Some changes happen in almost all of us with age, but heavy physical activity, trauma or simply genetic predisposition may accelerate these changes in some people.
The purpose of the MRI apart from establishing the diagnosis and excluding other causes, is also to see if there are such changes which warrant surgery. By that I mean two main points which should be discussed with surgeon, whether there is narrowing of the spinal canal with compression of the spinal cord and whether there is compression of nerve roots at an extent which warrants surgery.
.
On the first point the report does shows some narrowing of the canal which, in some points in contact with the spinal cord. It speaks about mild deformity and stenosis though and doesn't mention any changes in the cord matter itself, so alone is not sufficient evidence for a need of surgery. It would indicate a need for surgery though if it was associated with signs indicating cord compression such as weakness of the lower limbs, increased reflexes, abnormal reflexes etc, signs which should be checked for by a neurologist or neurosurgeon. If no such signs are present then as I said MRI alone is not evidence enough for surgery.
Regarding nerve root compression, at C5-6 and C6-7 there is severe foraminal narrowing. The foramina are the side canals where the nerve roots exit the spine from. So severe narrowing may well cause nerve compression. However again that must be correlated with the symptoms. The imaging alone doesn't indicate a need for surgery if the patient hasn't no symptoms. Also there are several foramina narrowed so it must be determined which is causing the symptoms and needs intervention. So again the clinical picture is taken into account, location and distribution of the pain, sensation or muscle strength changes, lowered reflexes etc in determining the degree of suffering of individual nerve roots. When in doubt nerve conduction studies tests are also used.
So to conclude I believe that a surgeon consult is necessary especially since you say that conservative therapy with physical therapy and pain killers is not working. It doesn't mean that surgery will be done though careful evaluation of the symptoms is needed as well.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question and the MRI report carefully and I understand your concern.
That MRI report shows diffuse degenerative changes of the spine. These changes have happened over many years due to the wear and tear of the spine with time. Some changes happen in almost all of us with age, but heavy physical activity, trauma or simply genetic predisposition may accelerate these changes in some people.
The purpose of the MRI apart from establishing the diagnosis and excluding other causes, is also to see if there are such changes which warrant surgery. By that I mean two main points which should be discussed with surgeon, whether there is narrowing of the spinal canal with compression of the spinal cord and whether there is compression of nerve roots at an extent which warrants surgery.
.
On the first point the report does shows some narrowing of the canal which, in some points in contact with the spinal cord. It speaks about mild deformity and stenosis though and doesn't mention any changes in the cord matter itself, so alone is not sufficient evidence for a need of surgery. It would indicate a need for surgery though if it was associated with signs indicating cord compression such as weakness of the lower limbs, increased reflexes, abnormal reflexes etc, signs which should be checked for by a neurologist or neurosurgeon. If no such signs are present then as I said MRI alone is not evidence enough for surgery.
Regarding nerve root compression, at C5-6 and C6-7 there is severe foraminal narrowing. The foramina are the side canals where the nerve roots exit the spine from. So severe narrowing may well cause nerve compression. However again that must be correlated with the symptoms. The imaging alone doesn't indicate a need for surgery if the patient hasn't no symptoms. Also there are several foramina narrowed so it must be determined which is causing the symptoms and needs intervention. So again the clinical picture is taken into account, location and distribution of the pain, sensation or muscle strength changes, lowered reflexes etc in determining the degree of suffering of individual nerve roots. When in doubt nerve conduction studies tests are also used.
So to conclude I believe that a surgeon consult is necessary especially since you say that conservative therapy with physical therapy and pain killers is not working. It doesn't mean that surgery will be done though careful evaluation of the symptoms is needed as well.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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