Hi all. I had an MRI of ther cervical & thoracic region and got the result quickly.
Here is the narrative report: Please help with opinions:
There is posteoperative changes status post anterior cercial fusion from C3-C5 as well as posterior cervico thoracic fusion with stabilizing rods and bilateral anchoring screws at C4-C5 an C6. Posterior elmeents have been resectecd from C3-C7. There is no acute compression fracture. Vertebral alignment is normal. Theie is an accentuatet focal cervicothoracic kypshosic at the cervicothroacic juntion. there is severe disc space loss at C6-7. C2-3 and C7-T1 disc spaces are normal. Remaining disc spaces are fused.
There are stable focal abnormal increased T2 signal seen iwthin the cervical cord at the C5 vetebral body and also at the C6-C7 vetebral level where there is corresponding focal cord atrophy. Finds likely reflect myelomalacia.
Findings at the individual leveles limited due to suceptibility artifact from the fusion hardward.
C2-3 There is no significant disc abnormality nerual foraminal narrowing or central canal stenosis identified.
C3-4 No disc abormality post fusion. Bilateral uncovertbral joint spurring with mild foraminal narrowing on the right side. No central cord stenosis.
C4-5 No disc abnoramoity post fusion. Bilateral uncovertrebral joint spurring with mild foraminal narrowing. No central canal stenosis.
C5-6 No central canal or foraminal stenosis.
C6-7 No central canal stenosis on the sagitall images. Evaluation nondiagnostic on the axial images due to susceptibility artifact
C7-T1 No central canal or foraminal stenosis. No disc abnormality
The viualized paravertebral soft tissues are unremarkable.
CONCLUSION: Stable exam with postoperative changes as described above. No central canal or foraminal stenosis. Stable cervical cord mylomalacia.
Bilateral stablizing rods extend down to the level of T5. The vertebral boadies are normally aligned. The bertebral body heights are peserved. There is a T1-2 hemangioma in the T11 vertebral body. Focal disc signal is seen along the left anterior aspect superior endplate of T9 on T1 and T2 imaging with no corresponding signal alteration of the T2 fact saturation sequence. Similar apparing subtle sclerosis is seen in this region on prior CT from 11/4/2010. The visualized spina cord is normain in height.
Evaluation limited due to susceptiblity artifact particualry at the T2-3 and T4-5 levels.
There is a small paracentral disc protrusion at T5-6 and a small central disc protrussion at T6-7 T7-8. Minor disc bulging at T8-9 to T12-L1. No central canal or formainal stenosis. No thoracic cord compression.
The visualized paravertebral soft tissues are unremarkable. There is a 1 cm cyst versus nodule in the right thyroid lobe
Postoperative changes in the upper thoracic spine Small disc protrussions and disc bulging at multiple levels. No central cnald or foraminal stenosis. No thoracic cord compression
Any opinons on the bone spurring noted in the cervical region? Severe Disc space loss at C6-7 concerns me...comments? the mylomalcia and focal cord atrophy was noted on last years films.
Any opinions on the above report would be appreciated. Thank you
So is the loss of disc height at C6-C7 something new? Is all this surgery joined together? (meaning exactly what all is fused together?)
I'm just curious if you've stayed with the same surgeon who did the original surgery? I assume you have had other "opinions" through the years. I don't know enough about the original problems and surgery to ask any intelligent questions! I'm just trying to get an idea of what's going on and whether any revision surgery could be done at this point. I would assume not.
I would assume the bone spurs are just a continuation of the aging process...the body is still putting out osteophytes...although one might assume that if the area were truly stabilized, the body would sense that and stop trying to grow more bone to control the situation....
1. lumbar surgery for herniated discs; 1994
2. cervical surgery for foraminal stenosis; 1995
3. Lumbar surgery for flatback syndrom with harrington rods; 1997
4. Cervical surgery for kyphosis with harrington rods from C3 to T4 2000, this surgery was done both anterior and posterior. done in 2 parts. The fusion was done at levels stated in the initial posting.
The surgeries that I have had were done by various surgeons over the years. Yes the loss of disc height was NOT mentioned previously in the last report in 2011.
But what I also noted in the report it discussed "focAl dark signals at the T9 level if I am reading it right and then goes on to say SUBTLE SCLEROSIS? What does this mean sclerosis? Is it referring to MS or ALS a form of sclerosis? I'm scratching my head on this.
My symptoms especially in my cervical area consisted of centralized pain in spine region where I felt like my spine was being crushed; radiating pain into the shoulder areas; tingling and weakness feeling in the arms and fingers. Loss of strength when I try to pick things up or carry items.
My neurosurgeon over the past few years has noted a decrease in my neuro evaluation and saw that things were getting weaker.
I'm afraid your issues are too complex for my level of knowledge. But don't panic over the schlerosis...I can't tell you specifically what impact this has but in general, it is a hardening of the tissue -- I assume it would be similar to when the ligamentum flavum loses its elasticity and thickens...but in this case it is referring to the endplate at T9 and indicates (at least the way I read it!) that
[B]Similar appearing subtle sclerosis is seen in this region [U]on prior CT from 11/4/2010[/U].[/B]...in other words, the schlerosis was on the MRI from 11/04/2010...
As far as I can tell, it doesn't look like too much has developed since the last MRI. Everything appears to be pretty much the same -- the little disc bulges, etc. aren't creating a stenotic situation.
Last year my neurosurgeon was concerned about the myelomalacia and the focal cord atrophy in the cervical spine. While it may not have worsened it has created symptoms such as weakness in the arms etc.
He is afraid to touch me surgcially because first of all the surgeries that I have already been thru plus I have other issues such as I am diabetic and do I have kidney disease so surgery is more risky. To also get to the area for surgery in the cervical spine would require going thru the sternum to get to the area affected for surgery. A nightmare of a surgery as per my neurosurgeon.
I dont think there were issues with bone spurs in prior studies and the loss of disc space at C6-7 was not present in last years films or report.
Again I dont know what to make of it and what to expect when I see the doctor.
I can understand why it might not be wise to have any further surgeries. I see you are located in NJ. Have any of your surgeries been at HSS?
My guess is that the bone spurring is a part of the disease process with the uncovertebral joint arthrosis. As the loss of disc height occurs, the uncinate processes are pressed together. Osteophytes for in the disc space or are pressed into the adjoining foraminal opening...which results in radicular symptoms...which could explain the increase in arm weakness you are experiencing.
Yes, I originally lived in northern Jersey and had one surgery at HSS in 1997 for "flatback syndrome" with Harrington Rods. Great hospital. But the insurance plan I have now, they are not an "in network" provider.
I am no different from anyone else going thru back issues chronic pain etc. There are days that I don't know where to turn, or how I am going to get thru the day. I get depressed, I become secluded that I don't want to talk to anyone or see anyone.
But there are times I push things and I find it helps me. I am in therapy to help me deal with things. I have to realize to let the past go and not dwell on the future for all we really have in our lives is what we have right NOW. Nothing else is guarenteed for the future.
Also as I have mentioned in another post for the past 2 weeks I have been involved with homeless men via my synagogue. The program for us ends tomorrow but the past 2 weeks has uplifted me to forget about ME and concentrate on others. So that has helped me thru my own pain in helping others who are also in need and in their own pain.
For now I am trying to be optimistic and trying to figure out what my options are on the MRI results. Will have more input when I see the doctor and what his thoughts are.
I had given up before the intrathecal pump trial was done but that has given me hope. Who knows what is around the corner.
I thank the people at my synagogue for their recent support. I thank the people on this board for their kind words. And I thank this woman who I reconnected with from high school. We reconnected after 39 years apart & she had supported me thru the countless phone calls, countless emails. She heard my crys in the middle of the night when I could not sleep. She lifted me up and gave me unconditional support and love.
To all of you I say thank you and I love you all.
HI PB, it looks to me that the prior fusions (a.k.a. Findings at the individual levels limited due to susceptibility artifact from the fusion hardware.) are making it a "hard to read" MRI. At the C3-4 it notes joint spurring (bones spurs) with mild narrowing to the right side, which is probably why you're having the weakness & tingling in your arm. The rest in my opinion, looks normal. When is the pump date????
[QUOTE=pebblebeach3;510997He is afraid to touch me surgcially because first of all the surgeries that I have already been thru plus I have other issues such as I am diabetic and do I have kidney disease so surgery is more risky. To also get to the area for surgery in the cervical spine would require going thru the sternum to get to the area affected for surgery. A nightmare of a surgery per my neurosurgeon.[/QUOTE]
Dear pebble, I remember you mentioning this before a long time ago & this surgery sounds absolutely horrendous. Did your ns ever say under what circumstances would this surgery be necessary?Your MRI shows exactly what you have been through & also why you have such pain & this is only cervicothoracic, not lumbar. And you are still out helping others. I hope and pray that you never have to have this surgery & the morphine pump is soon to drop your pain, you deserve it. Take care, just a little longer, gmak
Last edited by gmak; 12-29-2012 at 11:20 PM.
I think there are probably several reasons why I am having weakness etc in my arms.
Part of it is due to the "Myelomalcia" which means softening of the spinal cord and while its been a while since I've read about Myelomalacia can be serious if it progresses.
Also there is "focal cord atrophy" I cant remember the exact levels but it is around the C4-5 C5-6 levels.
When I saw my neurosurgeon last year, he was concerned about both of the above items. We even compared films from 1988 and 2011. It was present in both sets of films and we were able to see a change for the worse over the yets. It appears that it is a slow process and progression of the problem.
But what concerns me which was contained in the body of report it said "severe disc loss space at C6-7." So from this and not sure from the report if this disc height is loss how much of the disc is left? It appears that while some of the disc is still there sounds like it is heading towards vertebrae on vertebrae the way I am reading it.
I think the narrowing and the bone spurs plus the above are all contirbuting to my issues.
The date for the pump is 1/11/13 so just under 2 weeks away. And I am really looking forward to having it done to get some relief.
GMAK as to reading the films I have had this issue before. The rods tend to interfere with getting clear pictures of what is going on. It is strange while I may not get complete readings on an MRI of the cervical spine, I have problems with the lumbar region as well. I have harrington rods from L2 to the iliac crest. The last time we tried for an MRI of the lumbar spine they could NOT read anything at all because of the interference of the rods. Dont know why I got somewhat of a reading in one area and nothing at all in the other region.
GMAK...as to the surgery on the cervical spine, he and I talked several times about surgery and the risks. First he was concerned about doing surgery on me especially this one because of the health risks. My diabetes to him is an issue and the fact that I have 1 kidney and in kidney failure in the other kidney, this is of big concern to him. When I talked to my nephrologist about surgery and the 1 kidney, while he felt that there are risks he felt they are low risks at this point in time.
But his concerns as well was the procedure itself which scared the heck out of him. He said the only way to reach the cervical area affected would be to go thru the sternum. The way he put it to me was that it would be a surgeons nightmare to go near me.
As to under what circumstances he WOULD do the surgery. We never went into a detailed conversation about when he would consider doing it.
Right now while I find it difficult to do thing and do have weakness in my arms I guess surgery would be discuss if and when it got to the point where I was not functioning at all. The problems that I have with my arms yes they are weak and my arms get strained very easily. I find sometimes that simple things like cutting my food while I can do it my arms get strained very easily. Or when I do go to the gym for the pool or to use the sauna I carry my gym bag which is not heavy at all, but again my arms get tired and strained very easily and I can't carry things for a very long period of time.
GMAK as to the volunteer work, I have cut back on what I was able to do. I would sleep over 1 or 2 nights in my synagogue on a cot while the homeless men are staying there. They need 2 men to supervise just in case the men need anything. I opted out of sleeping over this year. Me sleeping on the cots would have been suicide for me. I sort of knew last year that I had major trouble sleeping over. This project is extremely important to me helping others that are in need. So it lifts my spirits knowing that I am hoping help someone get back on track and see them succeed. It breaks my heart when I hear someone dropped out of the program and goes back to their former life.
As a final note I have been experiencing another issue. My mid back has been giving me issues. Its like when I was in the MRI machine I took a deep breath and felt a spasm/muscle cramping a tightening up which stops me. It doesnt last last and I have to find a way to relax so that it eases up. But this has occurred nurmerous times. Or like I get into my car to grab the seat belt and I feel a jolt. Not sure what or why this is now occurring but it is becomming an issue.
I will close for now, thank you all for your wishes, your thoughts, your support. I wish you all a Happy new year and may we all see some relief in the days to come. I love you all.
The Following User Says Thank You to pebblebeach3 For This Useful Post: gmak (12-30-2012)