MRI Cervical Spine Report - Fayis P (42M) - Explained

Patient Summary

What the Report Found - Finding by Finding

1. Multilevel Cervical Spondylosis (All Levels)

• Disc desiccation = the intervertebral discs have lost their water content and become dry and shrunken. Normal discs appear bright white on T2 MRI; desiccated discs appear dark.
• Spondylosis is the umbrella term for age-related degenerative changes: disc height loss + desiccation + osteophyte (bone spur) formation.
• Finding this at ALL cervical levels at age 42 indicates moderately advanced degeneration for his age.
• Osteophytes form as the body's attempt to stabilize the damaged disc space, but they can encroach on the spinal canal and nerve root exit foramina.

2. C3-C4: Left Neural Foraminal Narrowing + Left C4 Nerve Root Abutment ⚠️ (Most Clinically Significant)

• A disc-osteophyte complex = a combination of bulging disc + bony spur that acts as a hard ridge pressing on neural structures.
• Left posterolateral bulge = the disc is bulging toward the left side and backward, where the nerve roots exit the spinal canal through the neural foramen.
• Neural foraminal narrowing = the bony tunnel through which the C4 nerve root exits is now narrowed, compressing or irritating the nerve.
• Preforaminal abutment = the nerve root is being touched/pressed just before it enters the foramen - this causes the radiating numbness down the left shoulder/arm in the C4 dermatomal distribution.
• C4 nerve root distribution: innervates the top of the shoulder, upper trapezius, and periscapular area - perfectly matching his symptom of numbness radiating to the left shoulder.
• Importantly: no central canal compromise at this level - the spinal cord itself is safe here.

3. C5-C6: Ventral Thecal Sac Indentation ⚠️ (Second Significant Level)

• A broad-based posterior disc bulge means the disc is bulging centrally backward, pressing against the front (ventral aspect) of the thecal sac - the dural tube containing the spinal cord and CSF.
• Thecal sac indentation = the CSF buffer around the cord is being dented, but the cord itself shows no signal abnormality - meaning no myelopathy (spinal cord injury) yet.
• Canal diameter of 11.0 mm is at the low end of normal (normal >12 mm; relative stenosis 10-12 mm; absolute stenosis <10 mm) - so this is borderline but not yet critically stenotic.
• This level is worth monitoring because a further disc herniation or neck flexion could push it into cord compromise.

4. Spinal Canal Diameters

5. D1 Vertebral Body Hemangioma (Incidental)

• Vertebral hemangiomas are benign vascular tumors within the vertebral body, very common (found in ~10-12% of the population).
• The "trabecular pattern" (coarse vertical striations on imaging) is their hallmark appearance.
• No cortical expansion or extraosseous extension = completely benign, no treatment needed.
• This was found incidentally on the whole-spine screening sequences and has no bearing on his symptoms.

6. Cervical Cord - Normal

Sagittal T2 MRI from Adams & Victor's Neurology: severe cord compression with T2 signal change (myelopathy). Fayis's scan does NOT show this - his cord is still normal.

Clinical Interpretation

• Numbness/tingling in the neck and top of shoulder
• Pain radiating from neck to shoulder/upper trapezius
• Possible deltoid or diaphragm weakness (if severe)
• Reduced biceps reflex (if C4-5 involved)

Management

Conservative Management (First Line - Appropriate for This Patient)

1. NSAIDs (e.g., ibuprofen, naproxen) - first-line for pain and inflammation; no RCT data specific to neck, but widely used by analogy with cervical radiculopathy evidence.
2. Analgesics (acetaminophen/paracetamol) - adjunct for pain relief.
3. Muscle relaxants - for associated cervical muscle spasm (e.g., cyclobenzaprine, methocarbamol).
4. Soft cervical collar - limits anteroposterior neck movement, reduces nerve root irritation. Adams & Victor note it "may be sufficient to reduce discomfort in the neck and arms." Should not be worn 24/7 (leads to muscle atrophy).
5. Supervised physiotherapy - gentle stretching, cervical traction, posture correction, strengthening of deep cervical flexors. Avoid activities that provoke symptoms.
6. Epidural/foraminal steroid injection - if oral therapy fails, targeted fluoroscopy-guided injection can reduce radicular inflammation. (Note: higher complication risk in the neck vs. lumbar spine - vertebral artery dissection and cord injury are rare but reported.)
7. Activity modification - avoid prolonged neck flexion (e.g., looking down at phone), heavy lifting, overhead work.

Indications for Surgery

• Progressive motor deficit due to nerve root compression (not yet present in Fayis)
• Functionally limiting pain that fails to respond to 6-8 weeks of conservative management
• Spinal cord compression with myelopathy (not currently present)
• Sphincter disturbance - urgent indication

Surgical Options (If Needed)

Follow-up Plan

• Clinical reassessment at 6-8 weeks
• Monitor for red flags: upper limb weakness, hand clumsiness, gait disturbance, bladder/bowel symptoms (these indicate myelopathy and require urgent reassessment)
• Repeat MRI if symptoms worsen or new neurological signs appear
• The C5-C6 thecal sac indentation with borderline canal diameter (11.0 mm) warrants periodic monitoring even if asymptomatic

Summary in Plain Language

• C3-C4: A disc bulge + bone spur is pressing on the left C4 nerve root, directly explaining his left shoulder numbness.
• C5-C6: A central disc bulge is indenting the spinal cord's protective lining but NOT the cord itself - a "watch and wait" finding.