Question
Would you help me to understand the results of a MRI of the Thoracic Spine? In your opinion what is the prognosis for a 24 year old male? Also, could the findings be the cause of numbness, tingling, and  weakness of the hands?
Thank you.

Findings:
There is a normal flow void in the vascular structures.

There is a hemangioma in the T6 vertebrae.

There is normal signal intensity in the spinal cord and nerve roots.

There is posterior herniation of the T6-7 disc.
There is also posterior herniation of the TT5-6 disc.  
At both levels there is some effacement of the thecal sac.
The remainder of the thoracic spine has a normal MRI appearance.

Impression:
1. posterior herniation of the T5-6 Disc effacing the thecal sac.

2. posterior herniation of the T6-7 disc effacing the thecal sac.  

Answer
Dear Debbie,

Although disk herniations in the thoracic spine are rare, they do happen.  These are often because of trauma though and are really rare in younger individuals.

The MRI results basically say that the disks at the T5/T6 and T6/T7 have bulged backwards in to the spinal cord and are pressing on the outer coverings of the spinal cord called the meninges or thecal sac.  The thecal sac is comprised of three layers of tissue, and contains the cerebral spinal fluid, which circulates around the brain and spinal cord for protection and nourishment.  Thecal sac effacement is a significant finding as this can cause local inflammation and pain, but at least the bulges are not pressing on the actual cord.

The fact that there is normal signal intensity at the cord and the nerve roots is a good sign.  Increased signal intensity means increased inflammation, scar tissue, tumor processes etc... such as pathological changes.  This is not indicated from your report.

The hemangioma is a benign bone tumor that is commonly found in the spine.  They almost never turn into a cancerous process, and usually are regarded as an incidental finding requiring no treatment.  I wouldn't be concerned about it for a 24 year old male.  Realistically, I see absolutely no neurological compromise from these MRI results.

Concerning the numbness, tingling and weakness of the hands, the area of the spine that shows the disk bulges is too low.  The sensory and motor pathways into the hands arise from the nerve roots in the neck and upper back: C6, C7, C8, T1, and some fibers from T2.  The neurological pain pattern from T5, T6, and T7 go around the rib cage, and these MRI findings should not be associated with the symptoms you have described.  I would expect generalized mid back pain from these results, pain between the shoulder blades and just below them with some discomfort around the rib cage if the associated nerve roots were compressed or irritated.  As a matter of fact with the symptoms you have described, I would have ordered an MRI of the cervical spine, not the thoracic spine.

Prognosis for a healthy 24 year old should be good to excellent considering what has been documented. However, I am not seeing anything to account for the symptoms you have reported so the doctors should keep exploring the issue.  If he was examined in 5 minutes, then I would suggest that you get him to a doctor that will take the time to really look at the problem.  A functional orthopedic examination should be performed to include the neck, upper back and upper extremities.  This should include orthopedic and neurological tests, active ranges of motion, and some minor functional capacity such as muscle function and grip strength testing. It will take a minimum of 15 minutes after the history and vitals have been taken. I would suggest that you find a good chiropractic physician, preferably one with advanced training in sports injury or orthopedics to perform the evaluation, as this is what we excel at.

Good Luck Debbie, I hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net