MysteryWhiteBoy
10-08-2007, 02:59 AM
hello all...
i recently had an MRI done of c-spine...in short, i've had burning pain from left side base of skull down the back into shoulder blade area...as well as pain down my left arm into all fingers of the left hand. i'm a musician and it's been 1.5+ years of hell not being able to play more than 15 minutes at a time (esp. coming from doing 3 hour runs prior to all this). anyhow, here's what the report says...i'd appreciate any opinions/thoughts on how you interpret it:
IMPRESSION:
1. degenerative disk disease at the c5-c6 level.
2. broad-based central disk protrusion/extrusion at the c5-c6 level, causing mild central stenosis.
FINDINGS:
c2-c3: normal (paraphrasing, of course)
c3-c4: normal
c4-c5: 2mm central disk protrusion present. no significant canal or neural foraminal stenosis is noted. the facet joints are not hypertrophied.
c5-c6: there is disk desiccation and disk space height loss, consistent with degenerative disk disease. there is a tiny focus of increased T2 weighted signal intensity notes centrally within the posterior aspect of the disk, suspect for an annular fissure/tear. the latter is associated with a 3mm broad-based central disk protrusion/extrusion, causing mild central stenosis. the neural foramina are not narrowed. the facet joints are not hypertrophied.
c6-c7: normal
c7-t1: normal
of course, c5-c6 is where all the action is...some points in the analysis are obvious (DDD, etc.)...but i'm curious what the T2 portion of the report means, among others.
my physiatrist suspects double crush syndrome (since i have a mild case of CTS in my left hand and moderate cubital tunnel symptoms)...a NCV came up negative about a year ago...and my prior MRI from around the same period had a mild 2mm disk bulge at c5-c6, but nothing as detailed as what is shown above...clearly things are changing for the worse.
it should be noted that poor posture at the computer combined with years of guitar playing with a hunched forward shoulder (left side) is the likely culprit here. i have tried several rounds of physical therapy with little to no results...
unfortunately, i am starting to feel this gradually affect my right side in a similar way the left side started out over 1.5 years ago...
i will be following up with my physiatrist soon to have go over this in detail with me...until then your thoughts/opinions would be appreciated.
thx...
i recently had an MRI done of c-spine...in short, i've had burning pain from left side base of skull down the back into shoulder blade area...as well as pain down my left arm into all fingers of the left hand. i'm a musician and it's been 1.5+ years of hell not being able to play more than 15 minutes at a time (esp. coming from doing 3 hour runs prior to all this). anyhow, here's what the report says...i'd appreciate any opinions/thoughts on how you interpret it:
IMPRESSION:
1. degenerative disk disease at the c5-c6 level.
2. broad-based central disk protrusion/extrusion at the c5-c6 level, causing mild central stenosis.
FINDINGS:
c2-c3: normal (paraphrasing, of course)
c3-c4: normal
c4-c5: 2mm central disk protrusion present. no significant canal or neural foraminal stenosis is noted. the facet joints are not hypertrophied.
c5-c6: there is disk desiccation and disk space height loss, consistent with degenerative disk disease. there is a tiny focus of increased T2 weighted signal intensity notes centrally within the posterior aspect of the disk, suspect for an annular fissure/tear. the latter is associated with a 3mm broad-based central disk protrusion/extrusion, causing mild central stenosis. the neural foramina are not narrowed. the facet joints are not hypertrophied.
c6-c7: normal
c7-t1: normal
of course, c5-c6 is where all the action is...some points in the analysis are obvious (DDD, etc.)...but i'm curious what the T2 portion of the report means, among others.
my physiatrist suspects double crush syndrome (since i have a mild case of CTS in my left hand and moderate cubital tunnel symptoms)...a NCV came up negative about a year ago...and my prior MRI from around the same period had a mild 2mm disk bulge at c5-c6, but nothing as detailed as what is shown above...clearly things are changing for the worse.
it should be noted that poor posture at the computer combined with years of guitar playing with a hunched forward shoulder (left side) is the likely culprit here. i have tried several rounds of physical therapy with little to no results...
unfortunately, i am starting to feel this gradually affect my right side in a similar way the left side started out over 1.5 years ago...
i will be following up with my physiatrist soon to have go over this in detail with me...until then your thoughts/opinions would be appreciated.
thx...
Sponsor
sunshine221
10-08-2007, 03:05 PM
Your MRI sounds a lot less serious than many of ours. That said of course you want relief.
Don't discount the "bad posture at the computer" - the first thing I was told after surgery was to check chair position(had to buy a new chair), check keyboard height (ok at all three desks I use) and monitor position (ok at 2 of the 3 and I only use the third one once every other week for payroll). Also - I was told to buy (and use) a phone headset - basically I have it next to my main desk and if I am doing a support call where I'm typing I put the caller on hold and put it on.
good luck
Don't discount the "bad posture at the computer" - the first thing I was told after surgery was to check chair position(had to buy a new chair), check keyboard height (ok at all three desks I use) and monitor position (ok at 2 of the 3 and I only use the third one once every other week for payroll). Also - I was told to buy (and use) a phone headset - basically I have it next to my main desk and if I am doing a support call where I'm typing I put the caller on hold and put it on.
good luck
neckpatient
10-09-2007, 02:39 AM
Hello and welcome. maybe I can offer a little more info. Being a pianist that had to also give up my passion, I can related to what you are missing. So you have two things that don't help when you have any spine problems (guitar and computer!)
True your MRI isn't hat bad, but as a wise physician told me, you don't treat the MRI you treat the patient.
Out of the things I read, the one I would worry about is that possible fissure/tear. Material normally restricted to the center of the disc could be leaking and come in contact with tissues not inteded to be in contact and cause inflammation and kick off other processes. What can happen from a leak is that scar tissue can also form to try to seal the leak, sometimes it works, other times this causes more problems. It can also cause increased pressure in there. So even if your bulges (protrusions) resolve themselves, which sometimes they do, if there is a tear/leak you will continue to have symptoms.
See a neurosurgeon for evaluation. I would not go down the double crush road, until they resolve the neck issues. You might be surprised that sometimes they resolve that and the arm will improve - even in CTS suspected cases.
True your MRI isn't hat bad, but as a wise physician told me, you don't treat the MRI you treat the patient.
Out of the things I read, the one I would worry about is that possible fissure/tear. Material normally restricted to the center of the disc could be leaking and come in contact with tissues not inteded to be in contact and cause inflammation and kick off other processes. What can happen from a leak is that scar tissue can also form to try to seal the leak, sometimes it works, other times this causes more problems. It can also cause increased pressure in there. So even if your bulges (protrusions) resolve themselves, which sometimes they do, if there is a tear/leak you will continue to have symptoms.
See a neurosurgeon for evaluation. I would not go down the double crush road, until they resolve the neck issues. You might be surprised that sometimes they resolve that and the arm will improve - even in CTS suspected cases.
MysteryWhiteBoy
10-11-2007, 03:45 AM
thanks for the replies...
neckpatient - thanks for your insight. i agree with you and will look into the neurosurgeon route. but i must ask obvious question...the title immediately and logically implies that surgery is what i am looking at. of course, i would like to avoid this. in your experience, can/do they offer any relief outside of surgery?
also, have u had any experience with cortisone injections at the site of inflammation? my physiatrist may likely recommend i do this, but i am highly reluctant to do this out of concern this could make matters worse...my problem seems much more complicated than a single injection could resolve.
thx again...
neckpatient - thanks for your insight. i agree with you and will look into the neurosurgeon route. but i must ask obvious question...the title immediately and logically implies that surgery is what i am looking at. of course, i would like to avoid this. in your experience, can/do they offer any relief outside of surgery?
also, have u had any experience with cortisone injections at the site of inflammation? my physiatrist may likely recommend i do this, but i am highly reluctant to do this out of concern this could make matters worse...my problem seems much more complicated than a single injection could resolve.
thx again...
neckpatient
10-12-2007, 05:27 PM
The real experts in this stuff are the neurosurgeons and the orthopedic spine surgeons. None like to do surgery right away and most all like to do conversative measures like PT, injections etc. The only time they go for surgery first are when medically the patients shouldn't wait. They will take your case and lead the decisions and what alternative non-surgical measures to be tried. Your physiatrist could even work with that person, but it would be best to have at least a consult with the surgeon. They might spot a trouble that the others won't.
What type of injection did they say and where did they say they wanted to inject cortisone? I have had many types of injections. Epidural Steroids in the middle canal (interlaminar), epidural steroid injections at the nerve roots (transforaminal), interscalene nerve blocks in the front of the neck at the bottom of the roots as they pass through the clavical and scalene muscles. These injections may help your pain and inflammation and might help that tear. This is one of the conservative measures they offer to the majority of patients that have pain. Injections can also offer some diagnostic information about the pain generator.
What type of injection did they say and where did they say they wanted to inject cortisone? I have had many types of injections. Epidural Steroids in the middle canal (interlaminar), epidural steroid injections at the nerve roots (transforaminal), interscalene nerve blocks in the front of the neck at the bottom of the roots as they pass through the clavical and scalene muscles. These injections may help your pain and inflammation and might help that tear. This is one of the conservative measures they offer to the majority of patients that have pain. Injections can also offer some diagnostic information about the pain generator.
MysteryWhiteBoy
10-21-2007, 01:43 AM
neckpatient,
thanks again for the reply...
i recently saw my physiatrist again (although i think he's more of an ortho than a true physiatrist)...anyhow, he is recommending an epidural injection (not sure exactly where). he did mention after looking at my MRI that my disk protrusion does not seem to be impacting the nerve roots at c5-c6. so, my guess would be interlaminar?
because he doesn't feel very strongly about the absolute necessity to do this injection based on my MRI, he is suggesting that i try a different anti-inflammatory for a few weeks to see if i respond. he's put me on relafen (750mg, 2x/day). i've already tried naproxen, sulindac and lodine. although i must admit that i have been very nervous about the side effects of these meds and have not taken them to the extent i prob. should have...
so, i'm going to truly give this a shot and hope for the best...
in addition, he is ordering an EMG/NCV of upper extremity (both sides) since my pain goes all the way down my arms and into hands/fingers (moreso on the left side). hopefully this will give me a fuller picture of what is going on...but, i must say, as scary as it is to see the problems at c5-c6, it is somewhat of a relief to have found the likely cause of all of this (up until the most recent MRI results, it was all rather vague)...
thanks again for the reply...
i recently saw my physiatrist again (although i think he's more of an ortho than a true physiatrist)...anyhow, he is recommending an epidural injection (not sure exactly where). he did mention after looking at my MRI that my disk protrusion does not seem to be impacting the nerve roots at c5-c6. so, my guess would be interlaminar?
because he doesn't feel very strongly about the absolute necessity to do this injection based on my MRI, he is suggesting that i try a different anti-inflammatory for a few weeks to see if i respond. he's put me on relafen (750mg, 2x/day). i've already tried naproxen, sulindac and lodine. although i must admit that i have been very nervous about the side effects of these meds and have not taken them to the extent i prob. should have...
so, i'm going to truly give this a shot and hope for the best...
in addition, he is ordering an EMG/NCV of upper extremity (both sides) since my pain goes all the way down my arms and into hands/fingers (moreso on the left side). hopefully this will give me a fuller picture of what is going on...but, i must say, as scary as it is to see the problems at c5-c6, it is somewhat of a relief to have found the likely cause of all of this (up until the most recent MRI results, it was all rather vague)...