It's arrived.And I have to go back for a more detailed scan of my cervical (neck) spine on Wednesday.
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Thank you for referring this patient.
EXAMINATION DATE: 22/02/2022 Examination: MRI Spine Whole
EXAMINATION: MRI Spine Whole
CLINICAL INDICATION:
Multiple myeloma. Left leg weakness. Exclude myelopathy
TECHNIQUE
Routine imaging protocol
FINDINGS:
There is an old fracture of the odontoid peg with posterior displacement of the odontoid peg in relation to the C2
vertebral body. There is narrowing of the cervico-medullary junction. Although axial images have not obtained
through this level, the cervico-medullary junction appears to be atrophic with high T2 and STIR signal here in
keeping with myelomalacia.
There is minimal grade 1 anterolisthesis of C6 on C7. The C5-6 and C6-7 intervertebral discs are degenerate
and of reduced height. The other cervical intervertebral discs are dehydrated.
At C2-3 the left C2-3 facet joint is degenerate. No significant neural compression seen.
At C3-4 there are degenerative changes in the right C3-4 facet joint and uncovertebral joint with narrowing of the
right C4 neural exit foramen.
At C4-5 No significant neural compression seen and there are some degenerative changes in the right C4-5
facet joint.
At C5-6 there are degenerative changes in the uncovertebral joints and disc/osteophyte bars cause narrowing of
both C6 neural exit foramina.
At C6-7 there are degenerative changes in the facet joints and uncovertebral joints with some narrowing of the
right C7 neural exit foramen.
RAMSAY SPRINGFIELD HOSPITAL, Private & Confidential
Crisp, Ian, ID: 2328367, DoB: 10/11/1948,
Description: MRI Spine Whole, Study Date: 22/02/2022, Page 2 of 2
The rest of the cervical cord returns normal signal with no evidence of cord compression.
There is a scoliosis of the thoracic spine, convex to the right. Some of the mid and lower thoracic intervertebral
discs are degenerate.
There are minor posterior disc bulges in the lower thoracic spine but no significant neural compression or
foraminal narrowing is seen in the thoracic spine. The thoracic spinal cord returns normal signal with no
evidence of cord compression. Although there is a small far right dorsolateral disc bulge at T11/T12, this is not
causing compression of the right T11 nerve root.
There is a scoliosis of the lumbar spine, convex to the left. Minimal retrolisthesis of L5 on S1 is noted. The L2-3,
L4-5 and L5-S1 intervertebral discs are degenerate and of reduced height with associated endplate spondylotic
changes. The other lumbar intervertebral discs are dehydrated.
At L1-2, there is no neural compression. At L2-3 and L3-4, there are minor annular disc bulges. No neural
compression seen. At L4-5 there is a small annular disc bulge with a left lateral and far left lateral component.
This is causing left lateral recess stenosis and there is some impingement upon the left L5 nerve root in its
lateral recess. There is narrowing of the left L4 neural exit foramen but the exiting left L4 nerve root is not overtly
compressed. At L5-S1 No neural compression seen.
The lumbar thecal sac is adequate throughout. The conus is normal.
There is abnormal low T1 and high STIR signal in the mid and superior aspect of the L4 vertebral body. The
appearances may be due to degenerative change but myeloma involvement here cannot entirely be excluded.
No infiltrative bone marrow disease is seen elsewhere in the spinal column.
CONCLUSION:
There appears to be an old fracture of the odontoid peg with posterior displacement of the odontoid peg in
relation to the C2 vertebral body. This is causing narrowing of the cervico-medullary junction. Appearances
suggest that this is longstanding and there is myelomalacia and atrophy of the cervico-medullary junction with
high STIR signal. A neurosurgical opinion suggested for further evaluation.
There is abnormal signal in the L4 vertebral body which I suspect is due to degenerative change but myeloma
involvement here cannot entirely be excluded. No spinal cord compression seen elsewhere in the spinal column
and the lumbar thecal sac is adequate throughout.
I am recalling the patient for dedicated axial imaging of the cervico-medullary junction.
Reported by: Dr Sanjiv Chawda GMC: 3329005
Consultant Neuroradiologist
Reported by: Consultant Neuroradiologist
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Interesting reading, isn't it?
The neurologist's accompanying letter says
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Dear Ian
I have now received the results of your MRI scan of the whole spine
which was done on 22/02/22 at Springfield Hospital.
This does show severe multi level degenerative changes (wear and tear) some
of which are old. There is a fracture at the vertebral level of C2 (high neck)
causing some damage to the spinal cord - myelomalacia and a doubtful change on
the L4 vertebrae (lumbar) raising a suspicion for myeloma involvement.
These findings require review by a neurosurgeon and if you give your
consent, I can refer you URGENTLY to my colleague, Mr XXXXX. Please
find attached a copy of the MRI report. I also note that the Consultant Rdiologist,
Dr XXXXX is bringing you back for more
imaging of your neck and I will contact you once again with this result.
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I have of course agreed to see the neurosurgeon.
More later, including translation of some unfamliar medical terms
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