Is X Rays Cervical Spine?

Summary: Spine problem, if neglected, can become dangerous. Avoid problems later by getting alert now.

MRI of the lumbar spine obtained on 05/19/15 revealed at L2-3, endplate osteophyte formation and disc bulge contribute to a mild degree of spinal canal stenosis and a mild degree of bilateral neural foraminal compromise. At L3-4, a disc bulge eccentric leftward and endplate osteophytes formation are responsible for a mild degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a moderate degree of left neural foraminal encroachment. At L4-5, there is a diffuse disc bulge and endplate osteophyte formation which effaces the ventral aspects of the thecal sac and are responsible for a moderate-to-severe degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a severe degree of left neural foraminal encroachment. At L5-S1, a shallow disc bulge and endplate osteophyte formation contribute to a mild degree of left neural foraminal encroachment, without compromise of the spinal

      The radiographer’s job is to deliverer quality X-rays that have been ordered by the medical staff. Basic radiographs required to exclude a cervical spine fracture include lateral view, anterioposterior view, and an open-mouth odontoid view. The lateral view must include all seven cervical vertebrae as well as the joint space between C7-T1. If this is not possible because of patient size or condition then a swimmers view will be needed. The anterioposterior view should show all cervical vertebrae, while the dens and joint space should be visible on the odontoid view. These exams need to be completed in a timely matter while continuing to maintain cervical immobilization. The importance of obtaining quality X-rays cannot be overemphasized as the most frequent cause of missed cervical fractures is the result of inadequate films.

According to the American College of Radiology Criteria for cervical MRI, MRI may be beneficial in a patient with ongoing neck pain with no history of trauma or neurologic findings if the neck pain persists and there are degenerative changes demonstrated on plain

MRI of the lumbar spine performed on 10/30/14 demonstrated mild anterolisthesis and prominent degenerative changes at L4-5, resulting in contact and possible impingement upon passing L5 nerve roots bilaterally. There is moderate bilateral facet arthropathy at this level. Mild central canal narrowing is seen at L4-5. Mild chronic compression deformity, superior endplate of T12 is seen.

On the Statement of Medical Necessity on MG-2 form dated 03/14/16 by Dr. Charles Gordon, patient presented with neck pain. The symptom is alleviated by injections and medication. It is located in the mid neck area, trapezius muscle, and in lower cervical/shoulder area. It is d described as pressure, shooting and burning, and radiating to the scapula and shoulder. Plan is to undergo a left cervical facet rhizotomy at C3-4, C4-5 and C7-T1 then right cervical facet rhizotomy at C3-4, C4-5 and C7-T1.

Assessments are lumbosacral intervertebral disc disorder with radiculopathy, lumbar spondylosis without myelopathy or radiculopathy and myalgia.

In addition, CA MTUS criteria for the use of epidural steroid injections include an imaging study documenting correlating concordant nerve root pathology; and conservative treatment. As noted above, this is an appeal to the previously denied request on 02/09/16. The appeal letter states that the patient has low back pain. MRI report showed disc bulge at L5-S1 with left neural foramina narrowing. However, 01/06/16 progress report noted that there was no radiculopathy with a negative SLR on exam. The guidelines require documentation of radiculopathy on exam. In addition, there is no documentation of a trial or failure of conservative treatment, including PT, as recommended by the guidelines. Furthermore, there is no documentation of any focal neurological deficits on the exam that would indicate nerve pathology. The motor and sensory exam was normal. Medical necessity has not been established. Recommend

As per medical report dated 4/19/16, a lumbar MRI with and without contrast was requested to evaluate for a discogenic and/or facetogenic etiology for pain. MRI would also allow evaluation of conditions such as spinal stenosis.

Scharf utilized Diagnosis Related Estimate cervical category II and assigned an 8% Whole Person Impairment. Dr. Scharf noted the MRI study of the cervical spine right disc extrusion at C5-C6, but there are no verifiable radicular symptoms in light of the result of the EMG/NCV studies, despite the applicant’s subjective complaints of radicular symptoms into the bilateral upper extremities. Since there are no verifiable radicular symptoms, the placement into DRE category II seems appropriate.

Dr. Abiera had reviewed a September 3, 2010 MRI of the cervical spine that revealed central protrusion/herniation at C3/C4, left paracentral protrusion/herniation at C7/T1, Disc bulges C4/C5, C5/C6 and C6/C7, left paracentral extrusion/herniation at T3/T4 and straightening of cervical lordosis. In addition, Dr. Abiera noted an August 11, 2010 x-ray of the cervical spine which revealed blastic lesions, incidental Clay Shovelers Fractures of C7 and an August 11, 2110 x-ray of the thoracic spine which was

MRI of the lumbar spine obtained on 12/21/11 showed at L4-5 level, there is some mild loss of normal hydration of this nucleus pulposus representing early dessication changes, with a minor 2-3 mm subligamentous posterior disk bulge/protrusion slightly elevating the posterior longitudinal ligament indenting the thecal sac without spinal stenosis and neuroforaminal narrowing.

MRI of the cervical spine dated 08/17/16 showed at C3-4 and C4-5, there is mild posterior disc bulging.

The x-rays of Plaintiff’s spine showed normal alignment, no swelling, no fracture or dislocation and normal lordosis of the cervical and lumbar spine. Plaintiff’s left knee x-ray also showed no fracture or dislocation, but moderate decrease in the meduial articular joint space. Plaintiff was given a general diagnosis of neck pain, back pain, low back pain and left knee pain. Plaintiff was prescribed 3 sessions per week for 6 weeks of physical therapy.

DOI: 6/23/2015. Patient is a 44-year-old male assembler who sustained injury while he was reaching for a part, pulled axle from rack and felt pain in the cervical spine. Per OMNI, the patient is diagnosed with acute cervical sprain and cervical radiculopathy.