Clinical question: History of thoracic schwannoma, evaluate for recurrence. Signs and symptoms: Neck pain. Pre- and post enhanced thoracic MRI:Examination demonstrates stable chronic post operative changes of thoracic laminectomy without evidence of residual or recurrence of tumor/schwannoma.There is normal anatomical alignment of vertebra, with mild kyphosis without appreciable change since prior exam.Mild to moderate degenerative disc disease of the thoracic spine is again noted.There is a left ventral epidural hypointense defect at T6-T7 level consistent with a disc protrusion which results in flattening and posterior displacement of the cord without detectable signal abnormality of the cord or convincing evidence of central spinal stenosis. This finding demonstrate subtle interval progression since prior study.Mild bulging disc osteophyte complex on the left at T8-T9 results in subtle flattening deformity of the cord without detectable signal abnormality of the cord and similar to prior exam. Mild degenerative changes at other levels however without central spinal stenosis. Stable postoperative changes of prior laminectomy at T10-T12 without evidence of mass effect on the thecal sac.Nonenhanced lumbar MRI:T12-L1 demonstrate minimal degenerative changes of posterior elements and unremarkable otherwise.L1-L2 demonstrate mild degenerative disease and unremarkable otherwise.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise. Next line L3-L4 demonstrate mild degenerative disc disease and moderate bilateral facet and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild to moderate disc disease, moderate bilateral ligamentum flavum hypertrophy and to lesser degree of the bilateral facets with evidence of mild left facet effusion. There is mild grade 1 anterolisthesis, mild central spinal stenosis and mild left neural foraminal compromise. There is interval progression of degenerative changes at this level since prior exam.L5-S1 demonstrate moderate disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and moderate bilateral facet hypertrophic changes. There is a small right lateral disc extrusion best appreciated on axial T2 series 16 image 23 and sagittal T2/T2 STIR image 10 and 11. Findings results in right lateral recess compromise without central spinal stenosis. Moderate to severe right neural foraminal compromise is also noted.
1.Pre- and post enhanced thoracic MRI demonstrate postoperative changes of multilevel thoracic laminectomy without evidence of mass effect on the thecal sac. There is no detectable residual or recurrent social or normal. Moderate degenerative changes of thoracic spine with subtle interval progression of disc protrusion at T6-T7 on the left as detailed.2.Nonenhanced lumbar MRI demonstrate degenerative changes at L4-L5 with resultant mild central spinal stenosis as detailed. At L5-S1 there is extensive degenerative changes and a right lateral disc extrusion with resultant right lateral recess compromise. There is also right neural foraminal compromise at this level secondary to degenerative disease.