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Q. What are the signs of disk compression in radiological films?

Answered by
Dr. Muhammad Shoyab
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 20, 2022

Hello doctor,

I have a level II disc replacement involving C4 - C6 and a Mobi-C disc surgery scheduled soon.

I wanted to get your professional opinion on my CAT (CT) scan.

Thank you.

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Hello,

Welcome to icliniq.com

I have gone through all the bone window images (attachment removed to protect the patient's identity) of your uploaded CT (computed tomography). I found that the prosthetic discs at both levels are properly aligned parallel to the end-plates of the corresponding vertebrae and the other vertebrae. They are also correctly aligned with the midline of the spine, i.e., no right-left disparity.

However, the prostheses are protruded a few millimeters forwards with respect to the front surface of the vertebral bodies - the C4 - C5 is more prominent. I suggest you discuss with your doctor (spine surgeon) whether this is a severe condition or the way to address it. There are also osteophytes and posterior osteophytes at different vertebral levels, which are part of the aging process.

I hope you will find this information helpful.

Thank you and best wishes.

Hello doctor,

I appreciate your help. Can you please go over each level and tell me where the osteophytes are? Also, what are the overall impressions and implications due to these osteophytes?

Thank you.

#

Hello

Welcome back to icliniq.com

I will be glad to walk you through the analysis level by level.

Thank you.

Hello doctor,

Thank you so much. I appreciate your help.

#

Hello,

Welcome back to icliniq.com

Please find the level-by-level analysis listed below.

C2: Dens in the midline. Atlantoaxial distance is normal.

C2 - C3: Bridging osteophytes are seen along the anterior surface.

C4 - C5: Prosthetic disc is observed. Parallel to the adjacent end-plates, aligned on the midline, but luxated a few millimeters forward with respect to anterior surfaces of adjacent vertebral bodies. Narrowing of the facet joint on both sides.

C5 - C6: Prosthetic disc is noticed.Parallel to the adjacent end-plates, aligned on the midline, but luxated a few millimeters forward with respect to anterior surfaces of adjacent vertebral bodies.

Posterior osteophytes at C5 and C6 levels are observed.

I hope this helps.

Thank you.

Hello doctor,

Thank you for your reply.

Do you see any foraminal stenosis? Can you also comment on my X-Rays? I have attached my before and after X-Rays. Can you let me know if you see anything worth mentioning?

Thank you.

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Hello,

Welcome back to icliniq.com

On the X-Rays uploaded by you (attachment removed to ensure patient's identity). I notice that the C5 - C6 prosthesis was entirely accurate in position and has now moved perhaps only by one millimeter forward.

The C4 - C5 prosthesis was already a bit forward at the time of placement due to an obstacle by a posterior osteophyte and has now moved one to two millimeters further forward.

Regarding foramina, it is hard for me to comment upon the CT accurately, as it is hard to see the discs here. I can only say that there is no bony obstruction on the foramina.

I hope this information helps you.

Thank you.

Hello doctor,

Thank you, doctor, you have been of great help.

My problem is my MRI (magnetic resonance imaging) comes up distorted in the C4 - C6 region because of my prosthesis. My main concern is whether the doctor decompressed everything or not? Is that bone spur in the C4 - C5 positioned in a way that is hard to be removed? It is of inconvenience to me as I have pain in my neck and arm. Doctors suggest it can be muscle-related, but I am not convinced. Can you please help me with that?

Thank you.

#

Hello,

Welcome back to icliniq.com

Sorry to hear about your distress. About that osteophyte or spur at the C4 - C5 level. Its removal depends on the surgical approach, but I think it is of less concern than the slightly displaced prosthesis. If your doctor suggests some therapy and exercises to relieve the neck strain, I suggest you follow that. I expect you to be in a more comfortable situation.

I wish you all the best.

Thank you.

Hello doctor,

Thank you for being so helpful. I did bring up the prosthesis a little forward. My surgeon was not concerned about it. Given I am only ten weeks out and based on the radiographic films you saw. Do you think it is mostly clear? And with time, will I notice any improvement?

Please let me know.

Thank you.

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Hello,

Welcome back to icliniq.com

Even I agree that there should have been some significant improvement after ten weeks, and of course, it is pretty distressing. However, in my professional opinion, I suggest you will benefit by consulting a surgeon or physiotherapist.

Best wishes.

Thank you.

Hello doctor,

Thank you for being so helpful. Can you help me understand if neurosurgeons or orthopedic surgeons need a radiologist report, or will they understand without them, just by looking at my CT scan?

Thank you.

#

Hello,

Welcome back to icliniq.com

I understand that you would feel more comfortable if you had a radiologist report in your hand, However, I think it would not be difficult to draw attention of the surgeon to two essential points:

1. Ten weeks is sufficient time, and there should have been some improvement.

2. The one to two millimeter forward slippage of the prostheses (as compared to postoperative X-Ray) - can it be ignored?

And overall, how to alleviate your pain and discomfort?

I hope you get good help from appropriate experienced specialists.

Thank you.


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