MyPACS.net: Radiology Teaching Files > Case 4123931

previously visited CERVICAL DISC HERNIATION C5-C6
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 52 year old female
History:
Neck pain and radiating right arm pain extending to the thumb with numbness.
Images:[small]larger

Fig. 1: LATERAL CERVICAL XRAY

Fig. 2: AP OPEN MOUTH CERVICAL XRAY

Fig. 3: APL5 CERVICAL XRAY

Fig. 4: LPO CERVICAL XRAY

Fig. 5: RPO CERVICAL XRAY

Fig. 6: T1 SAGITTAL

Fig. 7: T1 SAGITTAL

Fig. 8: T2 SAGITTAL

Fig. 9: T2 SAGITTAL

Fig. 10: T2 GRE AXIAL

Fig. 11: T2 GRE AXIAL

Fig. 12: T1 AXIAL

Fig. 13: T1 AXIAL
Findings:
RIGHT PARAMEDIAN DISCAL HERNIATION AT C5-6 COMPATIBLE WITH A PROMINENT PROTRUSION, POSSIBLY EARLY EXTRUSION, SHOWING MARKED HIGH INTENSITY SIGNAL CHANGES ON T2-WEIGHTED IMAGES. THIS HERNIATION HAS AN APEX OF APPROXIMATELY 6 MM CAUSING CORD COMPRESSION AND RIGHT C6 NERVE ROOT COMPRESSION AS OUTLINED IN ABOVE DISCUSSION.

Diagnosis: C5-C6 DISC HERNIATION.
Discussion: MR scanning (MRI) of the cervical spine is the best method of imaging the spinal cord and nerve roots, the intervertebral discs, and the ligaments. However it must be remembered that 50% of all adults have "abnormalities" in MR scans of the cervical spine. In the population over 40 years old, the frequency of these abnormalities was found by Boden et al to be as follows: bony spurs (70%), narrow discs (57%), degenerated discs (57%), herniated discs (13%), bulging discs (19%), and foraminal stenosis (48%). These findings have been confirmed by numerous other investigators. Therefore abnormal MRI findings can only be considered to be significant if a specific abnormality in the scan exactly matches the specific symptoms and signs of the patient. As an example, a patient complains of severe nerve root pain radiating all the way down the arm and forearm, numbness of the index and middle fingers, a has a weak triceps muscle and absent triceps tendon reflex, with aggravation of the arm pain during neck extension. In this case, the clinical diagnosis is clearly a 7th cervical nerve root compression. The only MRI abnormality that would be of significance in this case would be the finding of a herniated disc pressing on the 7th cervical nerve root as it lies on the C 6-7 intervertebral disc or as it travels out its intervertebral foramen or canal. This same MRI finding would be of no significance in a patient whose only symptoms were vague diffuse neck pain. Thus MRI findings can only be of value when they are interpreted together with and in the light of the entire clinical picture, and exactly match the clinical findings.
References:
Referring physician:  MARY DOYLE, DC

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Additional Details:

Case Number: 4123931Last Updated: 08-22-2007
Anatomy: Spine and Peripheral Nervous System   Pathology: Other
Modality: Conventional Radiograph, MRExam Date: 03-09-2006Access Level: Readable by all users
Keywords: cervical spine, herniations

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