MRI Results, need help understanding

[SSBB151]

Hi everyone,

I was referred to a rheumatologist after speaking with my primary about pain in my neck, traps, shoulder blades, and upper arms (I initially tested positive for an autoimmune disease but this turned out to be negative after further testing). My rheumatologist then sent me for an MRI and gave me the results today: she explained that I have one minor bulging disc, and that's all. When I asked further questions about how painful it is, she said this is not her specialty and she could only tell me what the report said. No medication helps, and I have made an appointment to begin physical therapy.

I now have a copy of the results. Please help me understand them because, right away, it seems that I have more than one issue (as she indicated).


MRI CERVICAL SPINE:

TECHNIQUE: Sagittal: SE T1, STIR, FSE T2. Axial: FSE T2, GE T2 (disc cuts C2-T1).

CLINICAL HISTORY: Neck pain, bilateral arm pain.

FINDINGS: No prior exams are available for comparison. The cervical spinal canal is normal in size and configuration. No acute fracture is seen. The craniovertebral junction and upper thoracic spine are normal. No areas of abnormal signal intensity in the spinal cord are identified. No intradural abnormalities, bony destructive lesions or paraspinal masses are noted. No bony or neural anomalies are identified. There is straightening of the cervical lordosis. No significant disc narrowing or degeneration is seen.

C2-3, C3-4, C4-5: Negative.
C5-6: Mild posterior bulging of the disc annulus is noted, causing very mild midline thecal sac deformity. Mild anterior osteophyte formation at this level is also seen.
C6-7: A small left-sided disc herniation is noted, causing mild left anterior thecal sac deformity.

IMPRESSION:
1. STRAIGHTENING OF THE CERVICAL LORDOSIS.
2. MILD POSTERIOR BULGING DISC ANNULUS, C5-6, CAUSING MILD MIDLINE THECAL SAC DEFORMITY.
3. SMALL LEFT SIDED DISC HERNIATION, C6-7, CAUSING MILD LEFT ANTERIOR THECAL SAC FLATTENING.
4. NO LATERAL DISC FRAGMENT, SIGNIFICANT SPINAL STENOSIS OR INTRINSIC CORD LESIONS ARE SEEN AT ANY LEVEL.

[philnoir]

Osteophytes are the scar tissue of degenerative arthritis. They are calcium deposits, sometimes called 'bone spurs' when pointy.

Loss of normal curvature (lordosis) occurs with diseased discs and facet joints. Consider a house with a crumbling foundation -- the house tends to tilt. Same thing is happening in your spine.

With a house, once can pour new concrete to level the house, but the human spine does not fix so easily.

Surgery often contributes to the problem because scarring occurs where surgeons cut, and tissue must be removed to gain access to bones and discs of the spine. While there are good reasons to do surgery in specific situations, surgery to manage the pain of mild spine disease is never a good idea.

Keep asking questions. When you learn more about the structure and function of the cervical anatomy, some of these answers will become evident.

[SSBB151]

Sleeping and sitting at the computer have been my two biggest issues so far, but I can't stop doing either (I have one year left in grad school). Many of my friends have suggested that my current issues are likely the result of the endless hours I spent hunched over my laptop writing papers. They're probably right. I've also found driving for more than 10 minutes to be very difficult, but fortunately most things I need to do are nearby.

Thank you very much for explaining these issues to me. What about straightening of the cervical lordosis or mild anterior osteophyte formation? I had bone spurs once before (if I remember correctly) and it was quite painful, maybe this could also be where the pain is coming from?

I appreciate the help with understanding these results. My rheumatologist couldn't explain it to me and I thought it may be silly to go looking for a spine specialist since I already know the issues. I'll be starting physical therapy tomorrow and hopefully will begin feeling better.

[philnoir]

Hello SSBB151 and welcome to the spine forum.

You have 2 disc problems at levels C5/C6 and C6/C7.

If you are not familiar with cervical spine anatomy, I suggest that you search for 'cervical spine anatomy' to learn about the vertebra, discs, spinal cord, and nerve roots.

The thecal sac contains the spinal cord. These discs slightly touch this sac, which can be a cause of pain. Pain can also come from the disc itself, it there are minute cracks in the annulus -- the tough outer ring.

Medical management and physical therapy are obvious choices for treatment at this point.

Find a skilled PT -- one who understands necks. You may get some relief with proper manipulation.

NSAIDs to reduce inflammation, and minor opiate pain relieve, like codeine, are good medical treatment options.

Always take NSAIDs as directed and with food, as these medications can damage your esophageal and stomach lining. Always take opiate analgesics as directed.

Because your disc bulges are mild, surgical intervention is not suggested.

You'll also have to learn the postural basics about living with an injured neck -- how to sleep, how to sit at the computer, etc. You'll find sources all over the internet on dealing with disc bulges. One tip -- support your head and neck at all times. Use a rolled up towel or pillow under your neck when you sleep. Avoid sudden motions.

Some people find chiropractic manipulation helpful, but chiropractic 'adjustment' of a neck with bulging discs is ill advised.

I imagine that most of your pain is now caused by inflammation. The NSAIDs and the physical therapy both reduce inflammation and increase your non-painful range of motion.

Ice is a great pain reliever. Obtain a flexible ice pack from your pharmacy, and use it. Never apply an ice pack directly to your skin -- wrap it in a dish towel.

Heat can also reduce the muscle spasm associated with neck pain. A heating pad, or preferably, a hot-moist pack can be applied to sooth a sore neck.

Swimming can strengthen neck muscles and loosen muscle tension. Other exercises can also help. Some people swear by Robin MacKenzie's book "Fix Your Own Neck."

Learning to manage the pain of spine disease can be stressful. So get all the help you need, and learn all you can about the nature of your disease, possible treatment options, and their outcomes.

Best wishes.