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Old 03-03-2011, 12:37 PM   #1
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Post Need help understanding MRI Report -ASAP

I recently tried to read an MRI report that the doctor only said "Your back is really messed up by this report." He never explained in lay mans terms what is actually wrong. i don't have a medical background and I need to understand what is going on. Can anyone help me decipher this MRI?

The MRI Reads as Follows: [B]MRI Spine W/O Cervical Radiculopathy
History: Bilateral shoulder and arm pain/ weakness, bilateral tingling/ numbness of the fingers.
Technique: Multiplanar, mulitisequense MR imaging of cervical spine obtained without contrast.
Findings: Motion limits T=the sagitta sequences. There is also mild motion artifact limiting evaluation of the axial plane.
No antero- or retrolisthesis seen. There is prominant anterior osteophyte formation on C5-6 and C6-7.
C2-3: No central canal or neural foraminal stenosis.
C3-C4: There is bilateral facet hypertrophy with mild to moderate neural foraminal stenosis, left greater than right.
C4-C5: There is a disk bulge with superimposed small central disk protrusion effacing the ventral thecal sac and causing moderate central canal stenosis.
mild bilateral neural foraminal stenosis noted, left greater than right. Bilateral hypertrophy present.
C5-6: There is a disk bulge with superimposed prominent paracentral disc herniation. There is flattening of the cervical cord and associated with severe central canal stenosis, especially in the left lateral aspect of the central canal. there is bilateral facet hypertrophy. There is right moderate and severe left neural foraminal stenosis. There is a focus of T2 signal identified laterally within the cervical cord on the right which suggests myelomalacia. Herniated disc material in the left lateral aspect of the central canal extends approximately 4mm below the level of the superior end plate of C6.
C6-C7: There is a disk osteophyte complex and mild flattening of the cervical cord with associated moderate central canal stenosis.
C7-T1: Bilateral uncovertebral and facet osteophyte formation seen. Mild bilateral neural foraminal and mild central canal stenosis noted.
There is a nonspecific T2 hyperintense lesion within the T2 vertebral body on the left, not imaged on the axial study. The lesion demonstrates no T1 correlation and is hyperintense on the STIR image.

 
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Old 03-03-2011, 02:06 PM   #2
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Re: Need help understanding MRI Report -ASAP

Hi Jessmainer....your neck is more than messed up. Your neck probably needs some surgery.

I interpreted Sassy's MRI and if you'd like, I can give you some help with yours. I do a lot of the MRI interpreting for the neck people who are on the Spinal Cord Disorders board(cervie hangout).

What I like to do is give an anatomy and terminology lesson so you can learn to understand them yourself.

The neck is different from the lumbar area. The vertebrae are much smaller and shaped a little differently. Even the spinal cord is different...it's oval instead of round in the neck.

Anatomy.....think of the shape of the vertebra as looking like a butterfly. If you held one in your hand and looked at the top side, the head of the butterfly is the front and that is where the disks are, and the tail end is where that spiky bone sticks out that makes us look like a stegasaurus. The wings to either side are the bulk of the bone. Right through the middle of the body(but more to the back than the front) is the spinal canal and where the wings pinch in, there are holes in the bone for the spinal nerves to leave. There are also blood vessels in there but since they aren't involved, we'll leave those alone.

At each vertebra, a pair of spinal nerves peels off like peeling a banana and leaves the spinal cord to exit the spine and go out to the body. The name of the holes they exit through is the foramina or neural foramina. So you have the vertebra with the spinal canal and inside of that is the spinal cord and the foramina for the spinal nerves that come off the spinal cord. Important distinction. If you looked at it from the front of your body, it would look like a long tube going down through the hole in the bone with smaller tubes peeling off and exiting the spine to the sides.....kind of like a highway with exit ramps on a map.

Between each vertebra, you have a disk to cushion the bones as you move. They are way up front where the head of our butterfly is. These disks are like jelly donuts with a fairly hard outside and squishy insides. Many things can cause these disks to dry out and shrink, leaving you without sufficient cushioning(and that hurts). The can also break open(herniate) and the squishy stuff oozes out. Doesn't go too far and hardens and can be a big cause of problems. If you get a break in the outside of the disk and the goo oozes out in the direction of the spinal cord or spinal nerves, it can push on them and cause major problems. If it hits the spinal nerves, it hurts. If it hits the spinal cord, it causes other problems.

So that is the basic anatomy. I'll explain the words as we look at each level of your test. I won't go into the significance of the type of MRI or T2 sequencing because it makes no difference.

So...at C2-3(they give as in between since that is where most of the problems are) you have no problems

C3-4-on the backside of the vertebra bone, you have some bumpy areas that act as joints(facet joints) and they work with the same joints above and below to stabilize you when you twist your neck. They have some arthritis. Arthritis causes bone spurs(hypertrophy or osteophytes) and those bone spurs are hitting the spinal nerves where they exit the bone. The amount of compression(pressure) on the nerves is rated as mild to moderate on a scale of minimal, mild, moderate and severe. You can go to "obliterated" and "very severe" but some radiologist don't. So if you give each level a number, you are 2 1/2 out of 4 in pressure with the worst area on the left.

C4-5-the disk has leaked and the stuff is pressing backwards towards the spinal cord and is in fact, pressing on the front(ventral) covering of the spinal cord(thecal sac) but not actually touching the spinal cord itself. Inside this "thecal sac" is the spinal fluid and they can still see fluid between the disk and cord. This has filled the spinal canal to a mild to moderate degree so again, in terms of how closed up your spinal canal is, it's a 2 1/2 out of 4 but still has room around the cord.

C5-6-big problems. The disk has really oozed out, so far that it is not only hitting the covering of the spinal cord but the cord itself and there is no room left for the cord. A 4 out of 4 on the closed up scale(severe central canal stenosis). On the right side of your spinal cord, this pressure from the oozed out disk is causing the cord to show signs of damage down to a depth of 4mms(myelomalacia). The cord is generally about 10mms thick. Then on the outside of the disk, you once again have arthritis of those little facet joints on the back and they have bone spurs that are pressing on the spinal nerves(the ones that leave the cord and exit). They listed the amount of pressure on the nerves as a 3 out of 4 on the right and 4 out of 4 on the left.

C6-7-Another oozing disk and it has formed bone spurs with the hardened ooze(disk osteophyte complex). It is big enough to hit the thecal sac and push right up against the cord and is just flattening it but no signs of damage to the cord is seen. Your spinal canal there is a 3 out of 4 in terms of how much room there is(Stenosis).

C7-T1-another set of tiny joints on the surface of the vertebra bone is the uncovertebral joints and both those and facet joints have arthritis with bone spurs(osteophytes). These bone spurs are causing "mild" (2 out of 4) closing up of the spinal canal and the holes where the spinal nerves exit(foramina) are also a 2 out of 4 in closing and pressure.

Have you seen a spine surgeon yet and what have they suggested as treatment? Can I ask what your symptoms are? Questions?

Class over

Jenny

 
Old 03-04-2011, 12:03 AM   #3
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Re: Need help understanding MRI Report -ASAP

The trouble with MRI reading is that it is the interpretation of the readings. Six radiologists will see the same but may well get six diagnoses. If you take an MRI of a well and pain free individual same age, same lifestyle as Jessmainer the looks of the films will be bye and large much the same. MRIs are fine if you have a tumour or infection but pathomechanical problems are another mater. It seems that many folks on this site are looking for a diagnosis for the cause of their chronic pain and once the diagnosis is made that it will be relatively easy to relieve it. It does not work like that for chronic musculoskeletal conditions, especially the spine. Injuries should be looked at in the early stages before chronisity sets in. Visits to multiple doctors, especially surgeons and radiologists, hoping for proof of their origin of the pain are almost allways disapointing. Doctor hopping, is not treatment, going to someone such as a physical therapist who understands chronic conditions, who realises that the brain is changed by a chronic pain and who is not going to give you useless modalities but will expain and rehabilitate you.
The longer you wait for real treatment the more chronic your condition can become.

 
Old 03-04-2011, 06:32 AM   #4
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Re: Need help understanding MRI Report -ASAP

Jessmainer, your doctor should be reprimanded for not trying to explain the report to you in a way that you can process. As jennybyc was writing, there appears to be evidence of bony changes to the vertebra of your neck, and disc herniation which ultimately mean that there is less space for your spinal cord and nerves to occupy as they pass through the constricted space of the spinal canal. Thus they may be getting pinched, squeezed, tractioned and inflamed, which will likely affect their function both sensory and motor.

 
Old 03-04-2011, 09:36 AM   #5
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Re: Need help understanding MRI Report -ASAP

Hi jessmainer, and welcome to the board. There isn't anything I can add to what jennybyc has explained to you. She did a supurb job of interpreting your MRI.

I am not impressed with a doctor who does not explain what is going on to his patient; to leave you hanging and looking for help elsewhere to learn what your problems are is not the kind of doctor I would want.

I would encourage you to seek at least 2 more opinions from spine specialists. There are 2 kinds of them...they have a fellowship in spinal surgery...one is an Orthopedic Spine Specialist and the other is a neurosurgeon who limits his practice to the spine. You have some major issues and need someone who will be willing to sit down and explain everything to you and then offer courses of treatment.

You should know that when nerves are being impinged after a period of time (and no one knows just when) they will become permanently impaired. That's why it is important to find a doctor in whom you can put your trust. Physical therapy is of little use for stenosis and can actually cause more problems, in my experience. There are conservative ways to manage the pain, but they are just band-aids and do not address the real problems.

I hope you will return and keep us updated as well as answering jennybyc's questions as that information will be helpful.

Best of luck to you.

Carol
__________________
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels

 
Old 03-04-2011, 10:14 AM   #6
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Re: Need help understanding MRI Report -ASAP

Jessmainer,
All I can say is the worst thing you can do is to see more and more spinal surgeons. You will eventually come to one who will be willing to operate on you. The more experienced surgeons and certainly the younger ones are operating on spines at a much lower rate than ever before. As for your MRI all your doc needs to tell you is that your MRI is just like anyone elses full of wear and tear and and you have nothing that is going to kill you.
The more surgeons you see, the more tests done the more your believe there is something sinister going on. Forget an anatomical diagnosis, it cant be done, get on with some treatment.

Last edited by james079; 03-04-2011 at 10:15 AM. Reason: spelling error

 
Old 03-04-2011, 10:54 AM   #7
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Re: Need help understanding MRI Report -ASAP

I'm hoping Jessmainer comes back to see my explanation but I will go ahead and add my 2 cents here.

The neck is very different from the lower back or any other place in the back. It is a very tight area with major nerves that can control things like breathing. So any injury must be taken seriously. You also have 2 major arteries to the back of the brain going up through the bones of the vertebrae from C6 to C3. Pressure on those from anything can result in a stroke. Neck problems can be life threatening.

Spine surgeons should not operate unless there is a risk of nerve or cord death. What is found in an MRI or CT should be correlated with the symptoms in the patient. An MRI can show severe compression on a nerve but the patient may show few symptoms of it. Conversely, a person may have obvious signs of nerve dysfunction but show only moderate compression on MRI. No doc makes a decision based on just an MRI. You must have the symptoms to verify what they are seeing on MRI.

Spine surgeons also should not operate to relieve pain from a compressed nerve as it may do nothing but can risk more problems. Studies have shown that surgery to relieve pain only work about 30% of the time and you have a 3% chance of ending up with paralysis. But if you have progressed to numbness, you have a 70% chance of that resolving(same 3% risk of paralysis), but when numbness hits, you are getting much closer to paralysis anyhow. A very recent study trying to find a DNA link to DDD, instead showed that those who don't get pain relief after surgery have similar genetic profiles as do those who do get pain relief. Surgery should be done to stop the development of paralysis not for pain.

If a nerve is compressed badly enough and long enough, you may start to develop paralysis of that one nerve. If the cord is compressed hard enough and long enough, you can be looking at paralysis of the entire body below that level of compression. Jess has compression bad enough to show injury to the cord at C6. Should take result in death of the cord at that level, it could result in paralysis from the waist down as well as hands and wrists. That will need surgery to stop it from happening.

But it will be up to the surgeon to decide IF it needs to be done based on the symptoms throughout the body. I had 4 levels of cord compression and my cord was compressed to half thickness(6mms.). I had numbness in my toes, thigh muscles that barely worked, making me walk with baby steps and a staggering wide gait, scattered areas of mild numbness on my legs, hands that did not function right and caused me to drop things a lot and trouble with feeling in my fingers. One NS said to wait longer as I could take more but another, a much better NS, said not to wait. In his opinion, because I had previous spine injuries, I was way to prone to soft tissue injuries and if any of those happened, I might not survive. Little did he know how right he was.

I chose to go with the new non-fusion rebuild of the back of my spine to relieve the pressure on the cord and nerves(cervical laminoplasty). Three months later I had that soft tissue injury and I dislocated 5 vertebrae and broke 3 of the 4 bone grafts put in, with 1 graft falling into the spinal canal and appeared to have impaled my cord. It was imbedded at the junction of left C6 nerve and the cord. That led to a C3 to T1 fusion and paralysis from which I have slowly recovered...most of it. Still have a bad left arm. My doc feared I would be permanently paralyzed but his amazing surgery once again, got me through.

So sometimes you do need surgery but it may not be for what you think. It's not to relieve pain but that may happen(or not). It's to stop the progression of damage to the point of paralysis.

One thing I have learned on these boards is that the outcome of your surgery is directly related to the expertise of your surgeon. Get the very best you can, preferably someone who teaches at a major medical school or spine program. Drive/travel to wherever you have to, to see the best your insurance can give you. It may be the difference between a life of pain and possible paralysis and living a fairly normal life with limited pain. I had massive injuries to my neck, now filled with titanium, and the only thing I take for pain is an occasional Tylenol.

My 2 cents. But it's based on personal experience.

Jenny

 
Old 03-04-2011, 11:35 AM   #8
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Re: Need help understanding MRI Report -ASAP

Jessmainer,

I have nothing to add to Jenny's interpretation of the MRI, but I did want to tell you I am sorry you are going through this.

I don't think "doctor hopping" is the same as seeking out more than one opinion. With a condition this potentially serious, it seems to me it would be wise to seek a 2d or 3d opinion before making any major decisions about treatment, including surgery.

Please keep us posted.

 
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