C4-C5 Disc Bulge with Foraminal Encroachment: Imaging Findings & Clinical Correlation

Imaging Description: "Minor bulging annulus or disc-osteophyte complex at C4-C5 with minimal impression on the anterior thecal sac and right foraminal encroachment."

Anatomic Breakdown

Potential Symptoms (C5 Radiculopathy)

• Pain: Neck, shoulder (deltoid region), lateral arm.
• Sensory: Numbness/tingling lateral forearm (C5 dermatome).
• Motor: Deltoid weakness (shoulder abduction), biceps weakness (elbow flexion).
• Reflex: Diminished biceps reflex.

Differential for Foraminal Narrowing

• Disc-osteophyte complex (most common).
• Uncovertebral joint hypertrophy (Luschka joints).
• Facet joint hypertrophy/ synovial cyst.
• Foraminal disc herniation (focal, not broad-based).

Management

1. Conservative (first-line): NSAIDs, activity modification, cervical collar (short-term), physical therapy (cervical traction, stabilization, nerve glides), cervical epidural steroid injection (TFESI).
2. Imaging follow-up: If progressive symptoms or myelopathy signs.
3. Surgical indications: Myelopathy, intractable radiculopathy >6–12 weeks, progressive weakness. Options: ACDF (anterior cervical discectomy/fusion), posterior foraminotomy, artificial disc replacement.

Key Point

"Minimal thecal sac impression" suggests no myelopathy. Right foraminal encroachment correlates with C5 radiculopathy. Clinical correlation is essential — many asymptomatic adults have similar findings.

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Term	Meaning
C4-C5	Intervertebral level between 4th and 5th cervical vertebrae
Bulging annulus	Circumferential extension of annulus fibrosus beyond vertebral endplates (>25% circumference), without annular tear
Disc-osteophyte complex	Chronic: disc bulge + marginal osteophytes (spondylosis) — broad-based, hard
Anterior thecal sac impression	Ventral displacement of dura/CSF space; "minimal" = no significant cord compression
Right foraminal encroachment	Narrowing of right C4-C5 neural foramen → potential C5 nerve root compression