I'm hoping to have someone decipher this a bit more clearly. The neuro that ordered this acted like the cold leg is significant, the pins/needles is significant, the purple foot is not, the reaction to anabolic steroids is significant, and the findings on the MRI could be significant but he won't rule out als and won't recommend un-necessary surgery to correct this herniation. WHY WON'T THEY FIX THIS? Again..I think it's because it's only un-necessary if he has als....even though this in combination with his stenosis and fusion and 2.5 yrs of compression could be causing his condition....in any other person walking in with this herniation plus neurological conditions, surgery would be recommended immediately.
Anyone have any takes on this MRI?
1. Sagittal T2, STIR, and SPACE, including dedicated high resolution sequences
2. Coronal SPACE
3. Axial T2 and diffusion tensor imaging, including color fractional anisotropy maps
4. Additional high resolution thin section axial T2
FINDINGS: The alignment of the thoracic spine is normal. There is multilevel degenerative change, with loss of disc height and signal particularly mid to lower levels. A focal central disc extrusion is present at T6/T7 that exerts mass effect on the adjacent thoracic spinal cord. The sagittal T2 and STIR images demonstrate very subtle increased signal in the ventral portion of the cord adjacent to this disc extrustion, although this finding is not confirmed on the axial images.
The thoracic spinal cord otherwise demonstrates no intrinsic signal abnormalities. The diffusion tensor images do not show localized decrease in anisotropy or diffusivity.
The vertebral body bone marrow demonstrates no suspicious signal abnormalities. The neural foramina are patent at all levels. T1 facet joints are normal at all levels. Incidentally visualized soft tissues of the thorax demonstrate no abnormalities.
IMPRESSION: Focal central disc extrusion at T6/T7 that exerts mass effect on the adjacent spinal cord. There is subtle abnormal signal within the cord at this level that suggests possible edema from mass effect, but the finding is not confirmed on all sequences and therefore indeterminate. No other definite abnormal cord signal is identified to correlate with suspected neurodegenerative condition.