What is the interpretation of the MRI (Magnetic Resonance Imaging) of the spine without contrast, and what are the next steps for the patient with cervical degenerative findings and multilevel canal and foraminal narrowing?

From the Guidelines

The patient's MRI shows cervical degenerative disc disease affecting multiple levels from C3 through C7, with disc bulges, ossific ridges, and arthritic changes causing varying degrees of spinal canal and neural foraminal narrowing, and the next step should be referral to a neurosurgeon or orthopedic spine specialist for evaluation. The most significant findings include moderate to severe foraminal narrowing at C4-5 and moderate narrowing at C5-6 and C6-7, with mild spinal cord compression at several levels. Given the degenerative changes and potential for neurological symptoms, it is essential to consider the patient's clinical presentation and correlate it with the imaging findings, as noted in the study by Okada et al 1, which highlighted the progression of disc degeneration and its correlation with symptoms. Conservative management may be initiated while awaiting specialist consultation, including:

• Physical therapy focusing on cervical strengthening and stabilization
• Anti-inflammatory medications like naproxen 500mg twice daily or ibuprofen 600mg three times daily with food
• Possibly muscle relaxants such as cyclobenzaprine 5-10mg at bedtime for muscle spasms If pain is severe, a short course of oral steroids might be considered, as suggested by the guidelines for managing cervical neck pain or cervical radiculopathy 1. The specialist will determine if surgical intervention is necessary based on the severity of symptoms and neurological findings, as the imaging shows significant degenerative changes that could potentially benefit from surgical decompression if conservative measures fail to provide relief. It is crucial to interpret the MRI findings in the context of the patient's symptoms and clinical presentation, considering that degenerative changes are common in asymptomatic patients, as noted in the study by Brown et al 1. Therefore, a comprehensive evaluation by a specialist is necessary to determine the best course of treatment and improve the patient's quality of life.

From the Research

MRI Spine Interpretation

• The MRI spine without contrast shows normal alignment, but there is narrowing of the disks from C3 through C7 with degenerative signal changes and cortical irregularity in the adjacent endplates.
• The vertebral bodies maintain normal height, and the marrow signal is otherwise normal.
• There is no abnormal signal in the cervical or visualized upper thoracic spinal cord.

Degenerative Findings

• At C3-4, there is a disc bulge with associated ossific ridge from the adjacent endplates, mild flattening of the ventral cord, and bilateral mild foraminal narrowing due to uncovertebral and facet arthropathy.
• At C4-5, there is a mild disc bulge with associated ossific ridge, and bilateral moderate/severe foraminal narrowing due to uncovertebral and facet arthropathy.
• At C5-6, there is a disc bulge with associated ossific ridge, ligamentum flavum thickening contributing to mild canal stenosis, mild flattening of the ventral cord, and bilateral moderate foraminal narrowing due to uncovertebral and facet arthropathy.
• At C6-7, there is a disc bulge with associated ossific ridge, ligamentum flavum thickening contributing to mild canal stenosis, mild flattening of the ventral cord, and bilateral moderate foraminal narrowing due to uncovertebral and facet arthropathy.

Next Steps

• According to the study by 2, multilevel developmental cervical spinal stenosis (DcSS) is a predisposing factor for degenerative cervical myelopathy (DCM), and the presence of DcSS can be predicted using MRI-based level-specific cut-off canal diameters.
• The study by 3 suggests that MRI of the cervical spine with neck extension may provide additional information on cord compression and neural foraminal narrowing, which could be useful in selected patients.
• The study by 4 found that a novel Cervical Phenotype Index (CPI) can predict postoperative symptoms of pain/disability and adjacent segment degeneration/disease after anterior cervical discectomy and fusion (ACDF).
• The studies by 5 and 6 demonstrate the reliability of assessing degenerative findings on MRI of the cervical spine, including disc degeneration, narrowing, and displacement, high-intensity zones, endplate abnormalities, Modic changes, and osteophyte formation.

Considerations

• The patient's symptoms and clinical presentation should be taken into account when interpreting the MRI findings and determining the next steps.
• The presence of multilevel degenerative changes and canal stenosis may indicate a higher risk of developing DCM, and close monitoring or early intervention may be recommended, as suggested by 2.