Just got another report on my neck. This is the third in 4 years. Up until now I've gotten mixed messages. Some say mild problems, others (neurosurgeons) say serious, need surgery. Hated last referral. He was extremely patronizing and refused to answer questions. So I had to pick up my report and the disc for my new specialist. The report is a bewildering list of several conditions at several levels, with the word severe appearing a lot.
I've got a couple of weeks before I see this doc. Can anyone help explain some of this?
First question: there is suspicion of central myelomalacia at C5-C6. I googled it and found that it could be caused by bleeding or constriction of blood flow to the area (C5-C6 has broad-based disc protrusion osteophyte complex, 3mm, ligamentum flavum thickening, moderate-severe central spinal stenosis, bilateral uncovertebral spurring with severe bilateral foraminal narrowing. So I guess it could be restricting blood circulation.)
All those neurosurgeons over the last 4 years who said I had to have surgery right away never once mentioned the possibility of permanent, irreversible damage to the spinal cord that could spread if the pressure were not relieved. But that's what my reading indicated. Am I right about that? Is there a reason beyond pain relief for surgery with stenosis?
The report said suspicion of myelomalacia. What's the next step in diagnosis of the condition?
Second question: Reading the report with the help of google made we wonder how I get up in the morning. The detail is overwhelming. Here's the impression, which I guess is a summary in order of seriousness, maybe. What should I be most concerned about?
4mm right foraminal disc protrusion at T1-T2, severe right foraminal narrowing, compression of right T1 nerve root.
Severe DDD, in cervical spine, worst at C4-C5 thru C6-C7
Moderate-severe central narrowing at C5-C6 (details above)
Moderate central spinal stenosis at C4-C5 & C6-C7
Multilevel foraminal narrowing. Severe on left at C3-C4, bilateral at C4-C5 thru C6-C7.
Welcome to the board. Do you know if your MRIs came from the same facility? Were earlier ones available to the doctor who looked at the new MRI? This is very important because MRI "interpretation" is somewhat subjective. Certain things can be measured, like the size of a ruptured disc, but other things, like stenosis, are subjectively diagnosed. It is possible (but not likely) that one doctor's "severe" may differ from another doctor's interpretation.
If the previous surgeons were explaining the recommendation for surgery, I would think they should have mentioned the possibility of paralysis to you. Any time the spinal cord is affected, one runs the risk of paralysis...so cervical issues always need to be examined in this light.
The reason for surgery when stenosis is severe is to prevent permanent nerve damage. If the nerve is not able to function, damage can occur to soft tissue, muscle, etc. along the path of the nerve. For example, if the L4 nerve is damaged, the person can end up with not only numbness or tingling, but the muscle can atrophy and/or become weak.
You definitely want to get the "suspicion of myelomalacia" figured out. This is done by MRI and/or myelography. This is a condition that would continue to deteriorate if left unchecked, but can be successfully dealt with surgically. It can result in paralysis if left undetected, so you want to specifically ask the new doctor about this finding.
The rest of your MRI is concerned with mostly degenerative changes that are contributing to the stenosis that exists in the central canal and in a number of the foraminal openings. The foramen are the openings through which the spinal nerves exit the spine and go out to the limbs and other areas of the body. Stenosis is a narrowing. This can be caused by several factors. A disc can bulge out of the disc space and press into a foraminal opening or into the central canal....a degenerating disc can form osteophytes which take up space that needs to be open so there is room for the nerves.
I'm not sure how to rate which level is more severe. You have "severe" neural foraminal stenosis at several levels...and in the central canal at other levels. My guess is that, if surgery is necessary, they will want to address all these issues at one time.
Thank you. Your reply is very helpful. The first two MRI's were done by a different facility and I never actually read the reports. The neurosurgeons showed me scary views from the first MRI and said that I had to have surgery right away or I would be paralyze next time I slipped on ice or got in an accident. I felt I was being given a sales job. They didn't give much detail when I asked questions. When I consulted a Doc of Physical Medicine he said that if it were he, he would not have surgery. I try to avoid surgery, of course. Most of us do, but I can't take opiates and other major pain meds, so post op times as torture.
Had they explained the situation, I would have responded differently and might have avoided the loss of small motor facility and strength in my arms and hands, as well as a lot of pain.
The new MRI does make one reference to the previous reports. It said that something was worse. It was also the first time I know I had any problem with T1-T2.