Diagnosis: Lumbago. Lumbosacral spondylosis without myelopathy. Brachial neuritis or radiculitis NOSClinical question: c/o upper abdominal pain, chest pain. Evaluate for thoracic disc herniation.Signs and Symptoms: abdominal pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.There is thickening of the cruciate ligaments at C1-2 without significant compromise to spinal canal.At C2-3 there is no significant compromise to the spinal canal or neural foramina. Small uncovertebral osteophytes associated with disc material are present on the right side at this level.At C3-4 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with disc material and encroachment of the exiting nerve roots within the neural foramina. There is bilateral facet hypertrophy present at this level - left worse than rightAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level - right worse than left.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is a broad-based left lateral disc protrusion at this level associated with a disc bulge. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.MRI thoracic spine:There is a soft tissue mass present behind the T12 vertebral body of the left lateral recess which is visually contiguous with the T12-L1 disc space. This extends into the left neural foramen at the T12-L1 and encroaches on the left-sided exiting nerve roots. There is mild spinal stenosis present at this level. This disk sequestration was also present on the 5/29/2015 exam. There are endplate reactive changes present anteriorly at T12-L1 with high signal on T1 and low signal on T2.There is mild narrowing of the right T9-T10 neural foramen related to some disc material and facet osteophytes.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Incidental note is made of a right renal cortical cyst in the small left-sided intraparenchymal renal cyst.
1.There are multilevel degenerative changes present in the cervical spine which result in encroachment of the exiting nerve roots bilaterally at C3-4 and on the left side at C6-7.2.There is a disc sequestration present at T12-L1 with extension of disc material into the left T12-L1 neural foramen and encroachment of the left-sided exiting nerve roots. There is only mild spinal stenosis at this level. There is no change in the extent of neural foramen and encroachment or narrowing of the spinal canal when compared to the prior exam from 5/29/2015. Endplate reactive changes at T12-L1 suggest some acute inflammatory change.