ADSUFTIN
10-12-2005, 03:46 PM
My husband got results of his MRI today. This is what it says:
1. At c5/c6, there is a prominent posterior ostheophyte/disc complex effacing the anterior subarachnoid space. There is narrowing of the neural foramina bilaterally. There are anterior ostheophytes. there is narrowing of the disc height.
2. There is a small central disc protrusion c6/c7.
3. There are anterior osteophytes c6/c7.
4. There is no central servical spine stenosis.
5. There are no focal abnormalities of the cervical spinal cord, which is normal configuration and signal intensity.
My question is: does he need a surgery? This is his second MRI in 5 months. The first one said that there is mild to moderate spinal stenosis (recent MRI states that that there are no spinal stenosis-where did it go?). With the first MRI 4 neuros said that he needs fusion at c5/c6/c7. I did not get reply from my neuro that recommended 2nd MRI. The reason that it was recommended is that my husband's symptoms (leg muscle spasms, numbness and tingling) went away almost completely. All 4 surgeons said that leg symptoms is the sign of the maelopathy. He still have occasional numbness in his hands and arms. He has no pain at all.
In you opinion, given an MRI result, will he need surgery?
Any response will be greatly appreciated.
1. At c5/c6, there is a prominent posterior ostheophyte/disc complex effacing the anterior subarachnoid space. There is narrowing of the neural foramina bilaterally. There are anterior ostheophytes. there is narrowing of the disc height.
2. There is a small central disc protrusion c6/c7.
3. There are anterior osteophytes c6/c7.
4. There is no central servical spine stenosis.
5. There are no focal abnormalities of the cervical spinal cord, which is normal configuration and signal intensity.
My question is: does he need a surgery? This is his second MRI in 5 months. The first one said that there is mild to moderate spinal stenosis (recent MRI states that that there are no spinal stenosis-where did it go?). With the first MRI 4 neuros said that he needs fusion at c5/c6/c7. I did not get reply from my neuro that recommended 2nd MRI. The reason that it was recommended is that my husband's symptoms (leg muscle spasms, numbness and tingling) went away almost completely. All 4 surgeons said that leg symptoms is the sign of the maelopathy. He still have occasional numbness in his hands and arms. He has no pain at all.
In you opinion, given an MRI result, will he need surgery?
Any response will be greatly appreciated.
Sponsor
hugo eve
10-12-2005, 05:41 PM
Hi
My opinion.... No. But go easy on himself ie No playing Grid Iron! Me mum had a traction device when I was little one and spent a lot of time in it to help her slipped discs in her neck. From a little kids perspective it looked like a B&D torture chamber (not that I knew what that was then, of course!). Anyway back to the point, she is now in her 80's and has never had surgery and has no problems and hasn't used the device or anything else for decades. I suspect her conditions was far worse than your old man's.
Mmmm...... a hereditary problem?
Hugz
Welded C4567
My opinion.... No. But go easy on himself ie No playing Grid Iron! Me mum had a traction device when I was little one and spent a lot of time in it to help her slipped discs in her neck. From a little kids perspective it looked like a B&D torture chamber (not that I knew what that was then, of course!). Anyway back to the point, she is now in her 80's and has never had surgery and has no problems and hasn't used the device or anything else for decades. I suspect her conditions was far worse than your old man's.
Mmmm...... a hereditary problem?
Hugz
Welded C4567
notpain
10-13-2005, 12:12 AM
Reread the first report. Anterior Osteophytes will probably not interfere with nerve function. Posterior Osterophytes narrowing the foraminal canals certainly could interfere if they get worse. Stenosis is narrowing - you can have foraminal stenosis and not spinal stenosis. Ostephytes cause stenosis at that level. I would investigate the C5/6 Problem further with the new Neurologist.
Remember that the radiologists often use different doctor language to explain the same thing. What is a bulge vs. a protrusion. The most important part is whether there is spinal cord compression. If it were me I would be very careful with my posture, get the opinion of the new Neurologist, and put the surgery off. You can always have it later (As long as there is not danger to permanent nerve damage).
Remember that the radiologists often use different doctor language to explain the same thing. What is a bulge vs. a protrusion. The most important part is whether there is spinal cord compression. If it were me I would be very careful with my posture, get the opinion of the new Neurologist, and put the surgery off. You can always have it later (As long as there is not danger to permanent nerve damage).
ADSUFTIN
10-13-2005, 05:38 PM
Thanks for answering. The first MRI had 2 large protrusions at C5/C6 and C6/C7. The second MRI had only one small protrusion at C6/C7. Where the other one go? Is protrusion the same as herniated disc? And if osteophytes cause stenosis, how come there are no mentioning either spinal stenosis or foraminal stenosis on the 2nd MRI report? What signal intensity means?
Thanks again for answering.
Thanks again for answering.
wimpette
10-13-2005, 06:02 PM
Many herniated discs resolve spontaneously on their own especially in the neck which might explain why his symptoms have improved and the second MRI shows a significant difference. You should check with the neuro who ordered the MRI and see what is opinion is, your husband might just get away with nothing for now except conservative therapy.
Let us know what happens,
W
Let us know what happens,
W
Unbearable
10-13-2005, 06:55 PM
I agree with Wimpette - many herniations will heal on their own...but may reappear later. Maybe not - this all sounds good to me. But watch the C-5-6
hugo eve
10-13-2005, 08:42 PM
ADSUFTIN: Wrote: "What signal intensity means?"
I believe I'm right in saying that this is the damage to the cord. The intensity of communication is increased with damage. When they tap you below the knee and on the sole, we with damaged cords have a larger reaction. (you would think it would be the opposite, wouldn't you). Home test that I do is to see if I can walk heal to toe in a staight line. This is a basic indication on the control of your legs. In the early days I was going arse over tit the whole time but now I'm well balanced.
Hugz.
I believe I'm right in saying that this is the damage to the cord. The intensity of communication is increased with damage. When they tap you below the knee and on the sole, we with damaged cords have a larger reaction. (you would think it would be the opposite, wouldn't you). Home test that I do is to see if I can walk heal to toe in a staight line. This is a basic indication on the control of your legs. In the early days I was going arse over tit the whole time but now I'm well balanced.
Hugz.
notpain
10-13-2005, 09:43 PM
you can have high signal intensity on the end plates where the discs meet the vertebrae. This shows potential damage (but how bad and not necessarily the cause of pain) but not causing cord damage. If you had actual chord damage the Neurosurgeon would see the disc pressing on the cord in the MRI. And if it was pressing on the cord a person would definitely have symptoms. That is not to say that it is not impossible. Keep in mind that the MRI films are done at different (for lack of the correct term) frequencies. They call them T1 and T2 if I recall. One shows fat better and the other water content better. The best thing to do of course is ALWAYS get a copy of your own films to keep with you and take to each doctor along with your reports. I see so many doctors that I always have my films with me and always take them at the end of the appointment.
hugo eve
10-13-2005, 10:18 PM
Hi
Thought I would cut and paste this off a website for a bit of clarification:
"The transverse area of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity changes were evaluated before and after surgery. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/normal, normal/high-signal intensity changes, and low-signal/high-signal intensity changes."
Though I think signal intensity is a generic medical term used for may different areas.
Okay, I'm off to pay my medical bills..... OUCH!!! (this is real pain). Got to skin a lot of crocs to pay for this!
Hugz.
Thought I would cut and paste this off a website for a bit of clarification:
"The transverse area of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity changes were evaluated before and after surgery. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/normal, normal/high-signal intensity changes, and low-signal/high-signal intensity changes."
Though I think signal intensity is a generic medical term used for may different areas.
Okay, I'm off to pay my medical bills..... OUCH!!! (this is real pain). Got to skin a lot of crocs to pay for this!
Hugz.
ADSUFTIN
10-14-2005, 09:16 AM
Hi
I can't tell you how much I appreciate your answers. We went thru four NS (and you know how hard it is to find a good one) with his 1st MRI and all of them said surgery.
Then, when my husband's symptoms almost dissapeared, one of them recommended 2nd MRI to see what's going on. My husband has an appointment with him on the 17th to decide if he will need a surgery. Living in NYC has an advatage of having the best hospitals and it is still hard to find NS that you can feel comfortable with.
I have another question that maybe you have an answer to. Can osteophytes be the reason of leg symptoms (muscle spasms, pain, etc...)without a cord damage or if the leg symptoms are present it is a sure thing that the cord is damaged and a person has maelopathy.
Thanks again You are great.
A.
I can't tell you how much I appreciate your answers. We went thru four NS (and you know how hard it is to find a good one) with his 1st MRI and all of them said surgery.
Then, when my husband's symptoms almost dissapeared, one of them recommended 2nd MRI to see what's going on. My husband has an appointment with him on the 17th to decide if he will need a surgery. Living in NYC has an advatage of having the best hospitals and it is still hard to find NS that you can feel comfortable with.
I have another question that maybe you have an answer to. Can osteophytes be the reason of leg symptoms (muscle spasms, pain, etc...)without a cord damage or if the leg symptoms are present it is a sure thing that the cord is damaged and a person has maelopathy.
Thanks again You are great.
A.
hugo eve
10-14-2005, 07:11 PM
AD Wrote: "Can osteophytes be the reason of leg symptoms (muscle spasms, pain, etc...)without a cord damage or if the leg symptoms are present it is a sure thing that the cord is damaged and a person has maelopathy."
Hi
Again a layman's opinion based on my own experiences: Osteophytes (bone spurs) can push onto the cord but if affecting the nerves leaving the cord they would affect upperbody more than legs etc if located in the cervical area. My first cord compression was @ c456 and was moderate and caused T2 scarring, my legs were compromised quite severely. It took 18 months to improve. My second cord compression C67 only affected my legs when I was leaning forward, lifting or looking up. It would take a day or two to come back to normal. There was no permanent damage and after fusion they have given no trouble at all (I'm so impressed, I feel as tho I've won the lottery, I thought my life was over as I knew it!).
Gee, I'm getting a bit serious lately, sorry about that. :confused:
Hugz
Hi
Again a layman's opinion based on my own experiences: Osteophytes (bone spurs) can push onto the cord but if affecting the nerves leaving the cord they would affect upperbody more than legs etc if located in the cervical area. My first cord compression was @ c456 and was moderate and caused T2 scarring, my legs were compromised quite severely. It took 18 months to improve. My second cord compression C67 only affected my legs when I was leaning forward, lifting or looking up. It would take a day or two to come back to normal. There was no permanent damage and after fusion they have given no trouble at all (I'm so impressed, I feel as tho I've won the lottery, I thought my life was over as I knew it!).
Gee, I'm getting a bit serious lately, sorry about that. :confused:
Hugz
ADSUFTIN
10-17-2005, 08:49 AM
Hi,
NS called Friday and said that my husband's last MRI is better than the one from 5 months ago, but he thinks that my husband still needs surgery. He said that this is up to my husband (I hate this wording). My husband doesn't know what to do. He doesn't have any symptoms of stenosis (except a little hands numbness, but he had this for years). What do you all think, should he go under the knife or wait until symptoms appear. Do you know people who had surgery when they did not have symptoms? Or should he consult yet another NS (5th) with this new MRI. I am going to FedEx MRI films to Dr. Jho today (if his office will give me OK).
It is all so frustrating.
Thanks for listening and replying.
A.
NS called Friday and said that my husband's last MRI is better than the one from 5 months ago, but he thinks that my husband still needs surgery. He said that this is up to my husband (I hate this wording). My husband doesn't know what to do. He doesn't have any symptoms of stenosis (except a little hands numbness, but he had this for years). What do you all think, should he go under the knife or wait until symptoms appear. Do you know people who had surgery when they did not have symptoms? Or should he consult yet another NS (5th) with this new MRI. I am going to FedEx MRI films to Dr. Jho today (if his office will give me OK).
It is all so frustrating.
Thanks for listening and replying.
A.
wimpette
10-17-2005, 02:11 PM
Given the fact that the MRI is better and that your husband's symptoms are minimal I would avoid surgery at all costs. The real reason for surgery is intractable pain or worsening weakness not responding to other modalities. An abnormal MRI without significant symptoms is, in itself, not a reason to undergo a major procedure.
There are many potential complications of surgery including worsening of symptoms due to failed fusion ,nerve damage, infection etc. So I would think long and hard before undergoing a major procedure with a prolonged recovery.
Good luck in your decision
W
There are many potential complications of surgery including worsening of symptoms due to failed fusion ,nerve damage, infection etc. So I would think long and hard before undergoing a major procedure with a prolonged recovery.
Good luck in your decision
W
hugo eve
10-17-2005, 06:47 PM
Hi Ad
Sometimes one has to look at the situation from the NS's angle. First of all he is a surgeon so his business is surgery. Secondly if he doesn't recommend surgery and your husbands situation deteriorates (no reason why it would) then he hasn't covered himself . Thirdly there is a huge financial incentive for him to operate. Would a neurologist have a less bias view?
Personally I would monitor the situation on a 6 or 12 monthly MIR basis for a while. What about the cyst?
Hugz
Sometimes one has to look at the situation from the NS's angle. First of all he is a surgeon so his business is surgery. Secondly if he doesn't recommend surgery and your husbands situation deteriorates (no reason why it would) then he hasn't covered himself . Thirdly there is a huge financial incentive for him to operate. Would a neurologist have a less bias view?
Personally I would monitor the situation on a 6 or 12 monthly MIR basis for a while. What about the cyst?
Hugz
ADSUFTIN
10-21-2005, 08:53 AM
Hi
I sent my husband's MRI to dr. Jho, they received it on 10/18 but he did not call me back yet. When I started to research endoscopic cervical surgery (similar to Dr. Jho's method), I came across couple of NY hospitals that do this procedure. Mount Sinai and Cornell. Anybody have info on this? And also, when my husband's NS is from Mount Sinai, but he doesn't perform endoscopic surgery, just good old ACDF. Is it ethical to consult with another NS from the same hospital who does perform this tipe of surgery?
And if there is no herniated disc, just spurs that are impinging on the cervical cord, do they also do ACDF? Or is there another procedure where they just "shaving" those spurs?
Thanks for reading this.
A.
I sent my husband's MRI to dr. Jho, they received it on 10/18 but he did not call me back yet. When I started to research endoscopic cervical surgery (similar to Dr. Jho's method), I came across couple of NY hospitals that do this procedure. Mount Sinai and Cornell. Anybody have info on this? And also, when my husband's NS is from Mount Sinai, but he doesn't perform endoscopic surgery, just good old ACDF. Is it ethical to consult with another NS from the same hospital who does perform this tipe of surgery?
And if there is no herniated disc, just spurs that are impinging on the cervical cord, do they also do ACDF? Or is there another procedure where they just "shaving" those spurs?
Thanks for reading this.
A.