Question
53 YO male History of prostate cancer ~5 yrs since prostatectomy, PSA is .10. C-5 ACDF 2 years ago due to long time ~10 years cervical spine issues. Recent upper backache sent me to the Dr. Led to MRI. Question is should I be seeing this kind of problem at C5? Seems like one operation with fusion would have fixed that level. Here is some of the report..

FINDINGS: There is anterior cervical fusion plate and screws
demonstrated from C4 through C6. There is an area of increased T2 signal demonstrated along the left aspect of the C5 vertebral body with extension into the left pedicle and subtle slight surrounding edema extending into the areas of the neuroforamen. This shows decreased Ti signal.

There appears to be some element of congenital central canal
narrowing throughout the cervical canal. Desiccated disk signal is present within the remaining cervical disks. Anterior osteophyte formation is greatest at C7-T1.

C2-C3: There is mild uricovertebral hypertrophy bilaterally leading to some element of neuroforaminal narrowing bilaterally. AP canal diameter measures 9 mm at this level.

C3-C4: There is predominantly left paracentral disk osteophyte bulge posteriorly at this level which indents the anterior thecal sac and contacts and contours the cord. AP canal diameter at this level is approximately 8mm.

C4-C5:   There may be some bilateral predominantly bony neuroforaminal narrowing demonstrate this level. AP canal diameter at this level measures 9 mm. There is increased T2 signal demonstrated posteriorly within the cord at the C5 level.

C5-C6:   Bilateral uncovertebral hypertrophy leads to bilateral neuroforaminal narrowing. The AP canal diameter is 10 mm.

C6-C7:   Mild disk osteophyte bulge posteriorly minimally indents the anterior thecal sac. AP canal diameter is 11 mm. Bilateral uncovertebral hypertrophy leads to bilateral neuroforaminal narrowing.

C7-Tl:   Disk osteophyte bulge posteriorly indents the thecal sac and contacts and contours the cord at this level. AP canal diametermeasures 10 mm at this level. There is bilateral significant neuroforaminal narrowing at this level on the left greater than right.

IMPRESSION:
1. Increased T2 signal demonstrated within the left aspect of the C5 vertebral body extending into the left pedicle is nonspecific and could be traumatic in nature versus infectious or inflammatory. Correlate clinically. No obvious adjacent diskitis but there is increased T2 signal demonstrated in the posterior aspect of the C5 cord at this level.

Answer
hi Jon

hmm- what caused you to have a plate fusion? anyway, that would only be helpful in stabilizing the vertebrae, and you don't seem to be having problems with instability in the area

'osteophytes' are like bone spurs, are often seen with the onset of arthritis or similar conditions- indeed most of what's going on in the mri seems to be bone-related (when they talk of foraminal narrowing, osteophytes, etc)

Do you have any numbness or muscle weakness? the places where the thecal sac is indented and/or the cord is 'contoured' by osteophytes could cause this

the 'impression' notes that the c5 issues could likely be due to injury, though whether current or in the past I do not know

so, in summary- (please remember, i am not a doctor- ) the fusion would probably not have fixed the things you're currently experiencing. As for whether or not the mri should cause concern- while not yet in the 'losing sleep over it' category, in my opinion anything too close to the cord is worth having checked out. I'd ask a doctor about the cause(s), is it likely to get better or worse, and what your options are

hope this is helpful, and
good luck

leslie