Please discuss the CT findings of the cervical and thoracic spine, including the mild straightening, uncovertebral arthropathy and osteophytes causing mild left and moderate right foraminal stenosis at C5‑C6, and advise on appropriate management.

CT Cervical and Thoracic Spine Findings: Clinical Interpretation and Management

Primary Findings Summary

Your CT demonstrates age-related degenerative changes with the most clinically significant finding being moderate right foraminal stenosis at C5-C6 from uncovertebral arthropathy and osteophytes. The mild left foraminal stenosis at the same level and the thoracic spine degenerative changes are common age-related findings that rarely require intervention 1.

Key Cervical Spine Findings

C5-C6 Level (Most Significant)

• Moderate right foraminal stenosis from bilateral uncovertebral arthropathy with small osteophytes represents the primary pathologic finding 1
• Mild left foraminal stenosis at the same level is present but less clinically significant 1
• Artifact limits central canal assessment, though no convincing disc bulge is identified 1
• Mild facet arthropathy contributes to the overall degenerative picture 1

Other Cervical Levels

• C2/3: Mild left facet arthropathy without neural compromise 1
• C3/4: Mild right uncovertebral arthropathy without neural compromise 1
• C6/7: Bilateral moderate facet arthropathy without neural compromise 1
• All other levels show no significant pathology 1

Cervical Alignment

• Mild straightening of cervical spine (loss of normal lordosis) is a nonspecific finding that correlates poorly with symptoms 1
• No fractures, instability, or prevertebral soft tissue swelling 1

Thoracic Spine Findings

Degenerative Changes

• Bridging anterior osteophytes at mid and lower thoracic spine represent diffuse idiopathic skeletal hyperostosis (DISH) or advanced spondylosis 2
• Mild facet arthropathy throughout without focal areas of advanced change 1
• Lower zone atelectasis is an incidental pulmonary finding unrelated to spine pathology 1

Reassuring Features

• No disc bulges or significant stenosis throughout thoracic spine 1
• Vertebral body heights and endplates preserved with no fractures 1
• No concerning bone lesions or soft tissue masses 1

Clinical Correlation Requirements

The critical next step is determining whether you have symptoms that correlate with the imaging findings, particularly right-sided C6 radicular symptoms. 1, 3

Symptoms Suggesting C5-C6 Right Foraminal Stenosis

• Right-sided neck pain radiating to shoulder, lateral arm, or thumb 3
• Numbness/tingling in thumb and index finger (C6 dermatome) 3
• Weakness in wrist extension or biceps (C6 myotome) 3
• Diminished biceps or brachioradialis reflex on right 3

Important Caveat About Imaging-Symptom Correlation

Degenerative changes on CT and MRI are extremely common in asymptomatic individuals over 30 years of age and correlate poorly with the presence of neck pain. 1 In a longitudinal MRI study, 85% of patients showed progression of cervical disc degeneration, but only 34% developed symptoms 1. Therefore, treatment decisions must be based on clinical symptoms correlated with imaging findings, not imaging findings alone 1, 4.

Management Algorithm

If You Are Asymptomatic or Have Minimal Symptoms

No treatment is required for degenerative changes identified incidentally on imaging. 1 The presence of foraminal stenosis without corresponding radicular symptoms does not warrant intervention 1, 4.

• Continue normal activities without restrictions 1
• No follow-up imaging needed unless new symptoms develop 1
• Reassurance that these findings are age-appropriate degenerative changes 1

If You Have Neck Pain Without Radicular Symptoms

Conservative management is appropriate, as the presence of degenerative changes alone does not require cross-sectional imaging or intervention. 1

• NSAIDs for pain control as needed 4, 3
• Physical therapy focusing on cervical range of motion and strengthening 4, 3
• Activity modification avoiding prolonged neck extension or rotation 4, 3
• Ergonomic adjustments for work/sleep positions 4, 3
• Minimum 6 weeks of conservative therapy before considering any interventional procedures 4, 3

Provocative cervical facet or nerve blocks are not supported by evidence and have high false-positive rates due to anesthetic leakage into adjacent spaces. 1

If You Have Right-Sided Radicular Symptoms (Arm Pain, Numbness, Weakness)

MRI cervical spine without contrast is the next appropriate imaging study to evaluate for nerve root compression and soft tissue pathology. 1

Why MRI is Recommended

• MRI is more sensitive than CT in identifying degenerative cervical disorders and soft tissue pathology 1
• CT cannot adequately visualize disc herniations, nerve root compression, or spinal cord signal changes 1
• The artifact limiting central canal assessment on your CT further supports the need for MRI if symptoms are present 1
• MRI provides superior visualization of neural foramina and exiting nerve roots 1, 3

Conservative Treatment During MRI Evaluation

• 90% of acute cervical radiculopathy patients improve with conservative management 3
• NSAIDs, physical therapy, and activity modification for minimum 6 weeks 4, 3
• Cervical collar immobilization may be considered for short-term symptom relief 3
• Surgical intervention is only considered for persistent symptoms despite adequate conservative therapy 3

When Surgical Referral is Appropriate

Neurosurgical or spine surgery consultation is indicated only if:

• Progressive motor weakness develops (e.g., wrist drop, grip weakness) 5, 3
• Symptoms persist or worsen despite 6+ weeks of structured conservative therapy 4, 3
• MRI confirms moderate-to-severe nerve root compression correlating with clinical symptoms 4, 3
• Significant functional impairment affecting activities of daily living or work 4, 3

Anterior cervical decompression and fusion (ACDF) provides 80-90% success rates for arm pain relief when appropriately indicated, with rapid symptom improvement within 3-4 months. 3 However, at 12 months, physical therapy achieves comparable clinical improvements to surgical interventions for true radiculopathy 3, emphasizing the importance of adequate conservative management trials.

Critical Pitfalls to Avoid

Do Not Pursue Intervention Based on Imaging Alone

The most common error is treating imaging findings rather than clinical symptoms. 1, 4 Moderate foraminal stenosis on imaging without corresponding radicular symptoms does not require treatment 1, 4.

Do Not Order Additional CT Imaging

CT has already provided maximal bony detail. 1 If further evaluation is needed for symptomatic patients, MRI is the appropriate next study, not repeat CT 1.

Do Not Rush to Interventional Procedures

Cervical provocative discography and facet blocks lack evidence support and have high false-positive rates. 1 The Bone and Joint Decade 2000-2010 Task Force concluded there is no evidence supporting these diagnostic procedures 1.

Recognize Red Flag Symptoms Requiring Urgent Evaluation

Seek immediate medical attention if you develop:

• Progressive weakness in arms or legs (myelopathy) 5, 3
• Gait instability or difficulty with fine motor tasks (buttoning shirts, writing) 5, 3
• Bowel or bladder dysfunction 3
• Bilateral arm symptoms or symptoms below the level of compression 5, 3

These symptoms suggest spinal cord compression requiring urgent MRI and neurosurgical evaluation 5, 3.

Thoracic Spine Management

The thoracic spine findings require no specific intervention. 1, 2 Bridging osteophytes and mild facet arthropathy are common age-related changes that do not cause symptoms in the absence of spinal cord compression or fracture 1, 2.

• No follow-up imaging needed for thoracic findings 1
• Lower zone atelectasis may warrant clinical correlation if respiratory symptoms present, but is unrelated to spine pathology 1

Summary Recommendation

If you are asymptomatic, no treatment or follow-up is needed—these are age-appropriate degenerative changes. 1 If you have right-sided arm pain, numbness, or weakness, proceed with MRI cervical spine and minimum 6 weeks of conservative therapy including physical therapy and NSAIDs. 1, 3 Surgical consultation is only appropriate for persistent radicular symptoms despite adequate conservative management with MRI confirmation of nerve root compression. 4, 3