Question
This is my first MRI on 3/19/09:

Findings: There is mild straightening of the thoracic spine. Minimal degenerative disc disease is noted throughout. The marrow signal is within limits.
   The thoracic spinal cord demonstrates normal signal intensity without evidence of an expansile mass lesion. the conus terminates at the level of the L1 vertabral body.
   T2-T3: There is a focal central disc protrusion measuring approximately 3mm in AP diameter with flattening along the ventral aspect of the thoracic spinal cord. There is no significant spinal canal narrowing or foraminal narrowing at this level.
    T7-T8: There is a minimal broad based disc protrusion measuring approximately 1mm in AP diameter without significant foraminal narrowing or spinal stenosis.
    No other significant disc herniations, areas of foraminal narrowing, or central spinal canal stenosis are identified. However, there is probably a poterior midline tear involving the T3-T4 disc.

Impression:
    1. Small central disc prorusions noted at the T2-T3 and T7-T8 levels without significant foraminal narrowing or spinal canal stenosis.
    2. Posterior midline annular tear involving the T3-T4 disc.




The second MRI was done on 4/7/09

    Findings:

The posterior fossa and craniocervical junction are intact. The cervical spinal cord is of normal calibur and signal intensity. There is straightening of teh cervical spine which may represent muscular spasm versus strain. The marrow elements are intact. No paraspinal lesion is evident.

At C2-C3, the central canal and neural foramina are intact.
At C3-C4, no significant stenosis is identified.
At C4-C5, the central canal and neural foramina are intact.
At C5-C6, no significant stenosis is identified.
At C6-C7, no disc protrusion is appreciated.
At C7-T1, the central canal and neural foramina are intact.
At T1-T2, the central canal and neural foramina are unremarkable.
At T2-T3, there is evidence of a central disc protrusion which effaces the ventral portion of the thoracic cord. Disc protrusion measures approximately 3.5mm.
    Impression:
1. At T2-T3, there is evidence of disc protrusion which is small in size. There is effacement of the ventral portion of the thoracic cord at this level.
2. No focal disc protrusion or stenosis is identified within the cervical spine.


My 3rd MRI was done on 9/4/09

     Findings:
There is normal alignment of the thoracic spine. Normal marrow signal intensity is noted. Mild degenerative disc disease is present, not appreciably changed.

The thoracic spinal cord demonstrates normal signal intensity without evidence of an expansile mass lesion.

There are small central disc protrusions noted at the T2-T3, T3-T4, T7-T8, and T11-T12 levels, not appreciably changed without significant central spinal canal narrowing or foraminal stenosis. Posterior midline annular tears are likely present in the T2-T3 and T3-T4 disc protrusions.


    Impressions:
1. Stable mild degenerative disc disease in the thoracic spine with several small protrusions, not apprecially changed, as above.
2. No evidence of fractures.



I know that is alot and it would really help if you could tell me what all of that means. I got hurt at work so this is a work comp case and all the doctors that i have seen seem to keep giving me the run around and i just want this pain to go away. I am so tired of dealing with it and the doctors making me think that it is all in my head. My pain is mainly on the left side of my upper back, in between may shoulder blade and my spine, from there on up to about the T1 spot. I get sharp stabbing pains. And a lot of the time i get a constant stabbing ache. I have had radiating pain around the front of my ribs on the left side. Also i have had some weird pains in my left arm. Occasionally i will have that stabbing pain on the right side of my back in between the shoulder blade and the spine also. I can seem to lift push pull and most of the time it does not hurt but give it about an hour and i am regreting whatever i did. I get the sharp stabbing pains. And then sometimes i can slouch and i get a stab or reach behind or above me and i get stab. Sitting in a car or chair for long is excrusiating. The work comp docs that i have seen still have not given me any kind of diagnosis yet. I just want this pain to go away. I am 27 yrs old and i really don't want to live with this pain for the rest of my life. Please can you give me any answers???  Thank you for your time.       Tiffany Smith


What i would really like to know is:
1. What does all of that mean?
2. Could any of what is in the MRI be causing the pain i have in my upper back?

Answer
Hello, Tiffany.

Here's the pivotal sentence in all of that:

"There is straightening of teh cervical spine which may represent muscular spasm versus strain"

Disc protrusions, radiating pain, and "degenerative disc disease" all stem from muscular contractions along the spine, which pull upon vertebrae, change spinal alignment, compress discs, and often trap nerve roots, leading to radiating pain at a distance from the entrapment (such as your ribs).

Such muscular spasms can be made worse by activity until you recover control of the involved muscles and movements.

What you've left out is the nature of your work-injury.  That would be informative.

Generally, injuries cause reflexive muscular contractions that may become chronic.

May I direct you to my relevant write-ups:

http://www.somatics.com/whiplash.htm
http://www.somatics.com/movement.htm

The write-ups offer more clarifying explanation and a course of action (which would, of course, not be validated by worker's compensation doctors).

regard,
Lawrence Gold