How to Read a MRI of a Lumbar Herniated Disc Lower Back Pain Colorado Spine Surgeon
We're going to look now at a lumbar spine mri of a patient that has a disc herniation and again we see the side view spinal cord ending here nerve roots coming out and the white being cerebral spinal fluid the water these are the vertebra these are the discs the l one two two three and three four discs are normal the white on the inside the jelly is full of water the dark plies in the tire normal here at the four five level there is a degenerative disk you don't see the.
Normal white of a normal disc and you see a small tear in the back of the disc right there at the five one level it looks somewhat like the four five level as it's dark in the disc but you can see a complete rupture at the back of the disc and a disc herniation here which is filling up the spinal canal this is a typical disc herniation you can look at it now from the topdown view and will come down to the five one level no better yet.
We will start at three four here and here is that jelly filled donut the normal jelly on the inside the donut on the outside the sack of nerves here all of these black dots are the nerve roots the back of the disc is flat to concave this is normal we come down from that level to the four five level and here is a small tear in the back of the disc this is called an annular tear but the nerves behind that tear are not compressed therefore this patient shouldn't have any nerve pain from this tear.
How to Read a MRI of Cervical Nerve Compression Neck Pain Colorado Spine Surgeon
Now we're going to look at a cervical spine mri of a patient with arm pain the patient doesn't have much neck pain and he has no spinal cord dysfunction in this mri again you can see the spinal cord in the center surrounded by the white cerebral spinal fluid or water and the vetrebral bodies and the discs you can see a small disc bulge here and smaller disc bulges here and here since there's no real compression of the spinal cord the patient has no spinal cord dysfunction symptoms.
But if we do come to the right side we can see these spurs that are compressing out of the canal at these two levels and those are the spurs that are catching the nerve root on the right we can look at it from the top down view and we come up to the first level at c two three again spinal cord is clear the white csf water around it these are the nerve exit polls here in here the c two three level looks normal we march down to the c three four level.
And again spinal cord has room the nerve holes have room this one is a a little tight but it still has plenty of room come down to c four five again the nerve holes are free the spinal cord is free come down to c five six and here we see a nice big spur on the right side the left nerve root is exiting quite nicely the right nerve root here is compressed by the spur and this is one of the spurs causing this patient right arm pain.
We can pass by this level and go to the next level at six seven and again see the same thing the left nerve hole is free there's a big spur on the right nerve hole and this nerve is compressed and this is what's causing him the arm pain from the c seven nerve this is a side by side example of a normal level of the cervical spine and a level where there's nerve compression again we noted before this nice large spur is compressing the exiting nerve route right here where the nerve root on the opposite side is open.
How to Read a MRI of Cervical Stenosis with Spinal Cord Injury Spine Surgeon in Colorado
We're now going to discussa patient with a cervical herniated disc herniated disc in the neck and this person ended up having some spinal cord injury because of it so on this side view mri we saw on the normal one again brain is up here this is the spinal cord coming down through here again the white stuff cerebral spinal fluid these are the vertebra and again these are the discs we can look down at the c five six disc here and we can see that there is a.
Disc herniation back here you can see it's compressing the spinal cord and that spinal cord compression is causing this patient some symptoms of a condition called myelopathy or spinal cord dysfunction we can see the cord itself has a uniform color until we get here where we can actually see some increased white or signal change within the cord which is an indication of some problems with the cells within the cord we can look at it from the top down view and again this yellow line shows us where this cut is and this is normal here you can see the spinal cord.
Surrounded by the csf with the nerve exit zones and as we march down the spine we continue to see that the spinal canal is nice and wide open there's still plenty of cerebral spinal fluid around the cord up until the point that we get to the injury where we can see the herniation is causing significant deformation of the spinal cord and if you look carefully you can see this white area in the cord and if we go down to the level right below the herniation you can see the white area over the cord injury level.
Within the cord at the level below but this is the level of the herniation that is causing that compression this is a stir image of the spinal cord this is very similar to the t two image that we saw where the water was white you'll see with this stir image the water is still white but the fat back here and the fat in the bones is suppressed it allows us to see inflammation with a better vantage point and again if you follow the spinal cord and you see where the injury is you can see all of the edema in the cord because.
How to Read a MRI of the Normal Thoracic Spine Mid Back Vail Spine Specialist
We're going to now look at a thoracic spine mri which is normal so that you can use this to compare against any kind of images that you wonder if they is something that looks normal or not the thoracic spine like the cervical and lumbar spine has two separate sets of images the side view which we see here and the bottomup view which we see here again this line will know where we're making our cut in the middle so we can see where we are on the side view.
The thoracic spine is obviously a continuation of the cervical spine the spinal cord comes down from the cervical spine here and goes through the thoracic now it's not that the cord dissolves away here but the patient has a little bit of a curve in their back and you'll see that we can see the curve and the cord down here but it disappears here we look at the other image again we see the cord here and it disappears here that is normal and nothing to worry about but the cord itself.
Should have a nice signal consistency it should be dark they should be no spots in it there should be no lines running through it again on either side of the cord is the cerebral spinal fluid which is the water that the brain and spinal cord float in the vertebra that you see are the thoracic vertebra and they're separated again by the disc just like in the cervical lumbar spine a jelly filled donut the jelly on the inside under high pressure and the donut on the outside rings of collagen that.
Hold that jelly in there are sometimes you will see these black lines within the cavity of the thoracic spine and even sometimes cervial and lumbar this is because there's something called flow artifact the mri is a very still image it's like the old time pictures in the eighteen nineties where if you didn't sit very still you would have a ghost image well even though the patient is sitting still on the table there's still fluid in the cervical thoracic spine that's moving up and down and it creates these.
Linear lines which are normal and have nothing to do with anything that's wrong you can follow the spine out until you get to the foramen and again you can see the nerve root which exits out on the foramen here you can see the pedicle coming into the facet which connects the back of the vertebra above with the vertebra below we can look at it from the top down view here and what we're looking at again is the front of the vertebra the back of the vertebra the spinal canal the spinal cord sitting in this.
Cerebral spinal fluid here and these are the nerve exit zones here and these are the ribs which come out from the spine and these are the lung fields here and here and your aorta and vena cava in this area here and you can follow this canal up and down and you can look at every vertebra you can get to the center where you have the veins you can get to the area where you have the disc and then continue on again veins and get to the next disc.
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