I feel an ice pick-like pain in my back in T4 and T5 regions. Is it spinal stenosis?

Question

Hi doctor,

I feel like there is an ice pick in my back at my T4 and T5 region. I had cervical disc replacement three months back for the C5 and C6 area. Do you see any canal stenosis in this CT scan? Is there a difference in the thickening of the ligamentum flavum and calcification of the ligamentum? Or are the same thing said on a radiology report? Would you suggest an MRI for the further diagnosis of canal stenosis? Where can the pain come from if I have no canal stenosis, but my problem is right at the T4 and T5 regions? I am currently taking medicines for back pain.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for writing to us. I hope you are not in much discomfort. Images (attachment removed to protect patient identity) shared are of the CT (computed tomography) cervical and upper thoracic spine from C1 to T4 vertebral levels. Answers to your questions are following. There is no bony spinal canal stenosis in the CT scan images. CT scan shows bony structures. So any calcification or bony changes are best visualized in CT scan images. You do not have any bony spinal canal stenosis.

Ligamentum flavum thickening referred to hypertrophy and increased thickness of the ligamentum flavum, and it is a structure that supports the posterior column of the spine. Calcification is the deposition of calcium in the ligament. And thickening can be due to causes not involving the ligament's calcification. So when it is mentioned as calcification, then it is a more specific cause of thickening. MRI (magnetic resonance imaging) is always helpful to look for soft tissue causes and mild disc problems that can cause symptoms of the spine and are not visualized on MRI scans. If the pain is disturbing and persisting for over 15 days, I suggest an MRI scan to keep in mind that the implants in the C5 to C6 disc level are MRI compatible. Causes can be in and around the T4 and T5 region. It is possible to have a mild disc bulge or a compression of nerve roots or the surrounding soft tissues, or rarely it can be from the spinal cord.

Regards.

Answer 2

Hi,

Welcome back to icliniq.com.

Thanks for sharing images (attachment removed to protect patient identity). There was an unprecedented delay in uploading images in the system, and I waited to see the new images. The ligamentum flavum is a support to the spine. It is a fibrous structure. Due to degenerative changes, there can be thickening of the ligament, which causes restrictions in the spine's flexibility.

Less commonly, the thickening might involve calcium deposition as you have in T4 and T5 vertebral levels. This means mild calcium deposition in the ligament and causing a possible minimal decrease in spinal canal diameter. The details in the CT reports given to you is appropriate. Further, an MRI scan will confirm any minimal canal stenosis and nerve compression. As your CT scan shows signs of degenerative spine changes, the possibility of any other conditions is less and not likely.

Regards.