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Suggest treatment for mild diffuse disc bulge

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Posted on Sat, 16 May 2015
Question: what does this mean from my MRI findings:T1-T2 and T4-T5 diffuse disk bulge indenting the thecal sac can you take a look at this MRI Report and tell me what going on .
doctor
Answered by Dr. Dariush Saghafi (38 minutes later)
Brief Answer:
There is no MRI report or film that accompanies your question...sorry

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio region.

The human vertebral column or the spine is divided into several major segments. They are Cervical, Thoracic, Lumbar, and Sacral. Each segment is designated by a single Letter (C, T, L, S)...pretty easy, yes? Within each segment we have individual vertebral bodies designated as C1-C7 in the cervical spine, T1-T12 in the thoracic spine, L1-L5 in the lumbar spine, and S1-S4 in the sacral spine.

Between each vertebral body is a disc...or shock absorber. Between vertebral bodies T1 and T2 there is a disc and that is referred to as the T1/T2 junction or the T1/T2 disc. Similarly between the T4 and T5 vertebral bodies there is the disc. The thecal sac is the covering that surrounds the spinal cord which is placed delicately inside of the vertebral bodies through the spinal canal formed by each vertebral body stacked on top of another.

So, you know what the spine looks like, I'm sure....just imagine through the center of that bony column a spinal cord which is enveloped by a THECAL SAC. Now, imagine that you have discs between each vertebral body and that those soft gelatinous disks somehow PROTRUDE OUT OF THEIR PLACE. Depending upon how far they push one can say that they are either BULGING or HERNIATED.

In your case you have 2 BULGING DISKS which are not as bad as herniations. Herniations are usually very painful and difficult to treat with just medication because of the pain involved. At any rate, in your case you have 2 disks which are then, PROTRUDING out of their normal place or BULGING which is the more common term and causes the THECAL SAC to be indented or deformed at their junction. Now, sometimes that has clinical implications and sometimes it doesn't.

In about 40% of all people who have NO SYMPTOMS of back pain, numbness, tingling, weakness, spasticity, muscle spasms, cramps, etc. etc.....one can find DISK BULGES....so they are completely harmless in about 40% of people who have no pain symptoms to refer. However, in some people we believe that pain, numbness, tingling, and other symptoms may be caused by bulging discs....you didn't describe any clinical symptoms nor did you provide the films or the report.

I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 26 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (40 minutes later)
Reports sent
doctor
Answered by Dr. Dariush Saghafi (58 minutes later)
Brief Answer:
No reports are attached to either of these 2 questions

Detailed Answer:
My apologies but there are no reports attached in the usual way in which reports come along with these questions. I wish I was tech saavy enough to assist but I really don't know how to go through the procedure of attaching reports and uploading them. May I suggest you contact tech support of this network. They are usually pretty prompt and should help you get whatever report you wish uploaded.

In the mean time, you can solace in knowing that with what you described to me in your previous question there is no doubt in my mind exactly WHAT you've got as well as WHERE it is located and just how seriously is it affecting the local anatomy. In other words, it would not be overly disastrous if for some reason I could not see the films or the report so long as you faithfully copied out the IMPRESSION from the report.

The other option you have is to simply TYPE the entire report within the body of this message and send that to me if you're having trouble actually uploading the document.

Cheers!

I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 34 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (11 hours later)
My MRI is attatched to this I just pulled it up!





















doctor
Answered by Dr. Dariush Saghafi (24 hours later)
Brief Answer:
MRI reports received

Detailed Answer:
Thank you for obtaining the original MRI reports to review. Just to clarify....they were the REPORTS that you attached and not the FILMS themselves, correct?

As far as the MRI of the thoracic spine is concerned there is no change in my interpretation or explanation of what I originally wrote in the first message when compared to the details of the report itself. Please refer back to my first message for the explanation of what you were asking.

As far as the other reports are concerned I can comment as far as my expertise allows but please understand that I am neither a radiologist nor orthopedist that can give as detailed commentary as you may wish.

LUMBAR SPINE:

1. There is a retrolisthesis of L5 over S1 of Grade 1 degree. This means that the L5 vertebral body is overriding the S1 vertebra by about 25% of its longitudinal distance...in other words there is a mild MISALIGNMENT between those 2 vertebrae. This is usually seen in cases of degenerative arthritis or in people who have suffered traumatic injuries of the lower back. There is also a small disk herniation at this level

2. There is a similar misalignment going on at the L4/L5 area with L4 overriding the L5 body by about 25%. There is also narrowing of the orifices (foramina) through which the nerves at that level travel. Again, this is entirely consistent with degenerative arthritic processes or status post traumatic injuries which could result in scarring or the bone, calcifications, etc.

3. There is a bit of curvature of the lumbar spine to the right (dextroscoliosis) and this again is consistent with arthritic disease and often is present from a very young age. Does not usually occur as a result of trauma. It is a developmental type of problem.

RIGHT SHOULDER

1. There is tear of the bursal sac associated with the suprapinatus tendon (attaches to the supraspinatus muscle...part of rotator cuff) which extends for approximately 22 cm.

2. There is tendinitis of the infraspinatus tendon (attaches to the infraspinatus muscle) and again is part of the rotator cuff assembly. Arthritic disease is usually associated with these changes as well as stretch injuries or overuse injuries that can be seen in athletes or people who do a lot of lifting, pushing, pulling, etc. or in injuries from accidents and so forth.

3. At the top of the right shoulder (acromioclavicular joint; AC joint) there are similar degenerative changes causing a reduction in the space of the shoulder and bones making up the region. There seems to be some calcification of the region which is impinging upon the supraspinatus muscle itself and resulting in the accumulation of some inflammatory fluids in the region.

I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 52 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (11 minutes later)
Can you take a look at the orginal MRI & CAT scan from 2/12/15 from the accident.
doctor
Answered by Dr. Dariush Saghafi (22 hours later)
Brief Answer:
MRI from 2012 shows cervical spine arthritis and spinal canal stenosis

Detailed Answer:
Good morning. I will address this question for you in your initial set and then, ask that since this actually becomes the 4th response in the initial charged set that you reopen a new thread if you would like to carry on the discussion.

The MRI of of 2012 shows degenerative arthritic disease at disc levels C5/6 and C6/7. Things called osteophytes which are simply calcified bony spurs on the spine. They are sign of progressive arthritic changes taking place. They do not appear immediately following traumatic injuries. They are actually smooth and rounded as opposed to sharp or jagged edged things....you might think of very smooth pebbles or rocks sitting on the ocean floor where you XXXXXXX in with your feet...you notice how smooth those rocks are due to the erosion by the water since they are submerged...rarely do you find a sharp rock to step on....same with an osteophyte....it's "sculpted to smoothness" in a way and maintained because of the constant movement of the joint or point of mobility at that location so it should be smooth. Because the process involves time it is never acquired acutely but occurs or months to years and is not uncommonly found in people who may not even have symptoms yet.

With these 2 areas showing such changes the report reads that there is cervical spondylosis (degenerative arthritis). Furthermore, because of these osteophytes there is a bit of narrowing of the spinal canal through which the cord runs and this is referred to as spinal stenosis. It is ACQUIRED according to the radiologist's opinion which means OVER TIME, NOT ACUTE, TIME DEPENDENT which is linked to the slow development of the osteophytes.

Unfortunately your doctors did not obtain scans of the cervical spine in 2015 so there is no comparison that can be made to see whether or not there have been any progressions or improvements in your neck condition from a radiographic point of view. It's a little strange to me that they seemed to image every other aspect of the spine and shoulder and somehow decided that the neck wasn't needed even though it was scanned in 2012. Oh well...twas their decision so there you have it.

Again, I would very much appreciate your consideration for a HIGH STAR RATING for these responses and ask you CLOSE THE QUERY at this time but remain available if you would like to start a new set of questions.

Thank you for allowing me to help out.

You can always submit DIRECT QUESTIONS to my attention for response by landing on my page at: bit.ly/drdariushsaghafi

and following the instructions on how to send your questions to my attention. I will always be honored to answer you back within 24 hrs. or less.

All the best.

The query has required a total of 57 minutes of physician specific time to read, research, and compile a return envoy to the patient


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Suggest treatment for mild diffuse disc bulge

Brief Answer: There is no MRI report or film that accompanies your question...sorry Detailed Answer: Good evening. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio region. The human vertebral column or the spine is divided into several major segments. They are Cervical, Thoracic, Lumbar, and Sacral. Each segment is designated by a single Letter (C, T, L, S)...pretty easy, yes? Within each segment we have individual vertebral bodies designated as C1-C7 in the cervical spine, T1-T12 in the thoracic spine, L1-L5 in the lumbar spine, and S1-S4 in the sacral spine. Between each vertebral body is a disc...or shock absorber. Between vertebral bodies T1 and T2 there is a disc and that is referred to as the T1/T2 junction or the T1/T2 disc. Similarly between the T4 and T5 vertebral bodies there is the disc. The thecal sac is the covering that surrounds the spinal cord which is placed delicately inside of the vertebral bodies through the spinal canal formed by each vertebral body stacked on top of another. So, you know what the spine looks like, I'm sure....just imagine through the center of that bony column a spinal cord which is enveloped by a THECAL SAC. Now, imagine that you have discs between each vertebral body and that those soft gelatinous disks somehow PROTRUDE OUT OF THEIR PLACE. Depending upon how far they push one can say that they are either BULGING or HERNIATED. In your case you have 2 BULGING DISKS which are not as bad as herniations. Herniations are usually very painful and difficult to treat with just medication because of the pain involved. At any rate, in your case you have 2 disks which are then, PROTRUDING out of their normal place or BULGING which is the more common term and causes the THECAL SAC to be indented or deformed at their junction. Now, sometimes that has clinical implications and sometimes it doesn't. In about 40% of all people who have NO SYMPTOMS of back pain, numbness, tingling, weakness, spasticity, muscle spasms, cramps, etc. etc.....one can find DISK BULGES....so they are completely harmless in about 40% of people who have no pain symptoms to refer. However, in some people we believe that pain, numbness, tingling, and other symptoms may be caused by bulging discs....you didn't describe any clinical symptoms nor did you provide the films or the report. I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you. Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary. Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 26 minutes of physician specific time to read, research, and compile a return envoy to the patient.