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Old 11-11-2010, 11:14 PM   #1
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Need help understanding my MRI

I'm new here and had 2 MRI's done about 1 month ago. One cervical and one thoracic. I don't fully understand what they mean. Wondering if someone can help me understand them more clearly.

Cervical
Findings: There is a multimodal limited scoliosis, a levocurve in the midcervical region noted; could represent splinting.
At C4-5 there is a mild disc protrusion; slight extrusion complex central slightly more left paracentral that effaces broadly the anterior thecal sac mildly impinges the cord with limited AP diameter canal stenosis to 7.5 mm minimum. The cord is slightly deformed and non malacic. The exiting roots at the neural foramen are unremarkable. There is slight underlying spondylosis of a chronic character. There may be acute or subacute exacerbation.
At C5-6 chronic pattern of mild spondylosis with uncinate endplate bony hypertrophy towards the right slight toward the right anterior canal. Limited neural foraminal encroachment. There may be slight root abutment effect.

Impression:
1. At C4-5 slight underlying chronic spondylosis. Indeterminate age of a disc protrusion slight extrusion that accounts for limited canal stenosis central left paracentral with limited impingement of both ventral C5 roots with slight cord deformity.
2. At C5-6 chronic spondylosis with limited right neural foraminal encroachment without gross root effect.
3. Underlying probably chronic pattern scoliosis; may be in part related to the other findings.


For my thoracic MRI these are the findings:

Findings: There is gradual limited thoracic levoscoliosis evident.
Slight disc dehydrations from the cervicothoracic junction through T10-11.
At T11-12 mild spondylosis, endplate hypertrophy, loss of disc height more away from the canal; slight endplate hypertrophy posteriorly without encroachment concerns.

Impression: Mild spondylosis at T11-12, limited more away from the canal without encroachment concerns; underlying limited thoracic scoliosis.



I really don't know what all this means. I do know I have tremendous upper/mid back pain and can not stand for more than 5-10 minutes without feeling like my back is breaking in half. When I stand or walk more I get numbness in my left leg. I wake up with both of my arms numb and always numbness running down my left hand from wrist to tip of pinky finger. I don't sleep well. I turn my body instead of turning my neck when driving. Sometimes my head feels like it weighs 50 pounds. I was injured in May 2010 and just had my MRI done in late September. I've had 1 epidural and it's been 1 week since then. Pain seems worse instead of better. I'm scheduled for another epidural next week. Can someone help me understand all this? I would sure appreciate your time.

 
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Old 11-12-2010, 06:48 PM   #2
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Re: Need help understanding my MRI

I want to bump this up in hopes someone will see this with knowledge and willingness to help me out here. Please?

 
Old 11-13-2010, 09:30 AM   #3
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Re: Need help understanding my MRI

jubilee1

My impression by reading the report is that you have a herniated disk that is affecting the nerve roots. The underlying spondylosis (narrowing of the spaces between the bones of your cervical spine) you have had for a while (chronic) however, when you were injured in May 2010, this injury exacerbated your previous chronic condition. My guess is that you have some form of arthritis and you have suffered an increase of inflammation because of this injury. I think that is why you are having steriod injections directly into the effective area. Did you get any relief of your symptoms after your first steriod treatment? If not, than I would get the second treatment, it you still have no relief, than call your doctor and tell him/her, that this treatment option is not working and you need an alternative.
I believe the reason for all your back pain numbness and tingling is due to the fact that you do have some cord compression.
What type of doctor are you currently seeing? I suggest that you seek out an opinion with a neurosurgeon, who can look at your current MRI exams and possibly give you some treatment options. This neurosurgeon needs to be experienced in spine disorders.
I had very similiar symptoms this past summer and I ended up having cervical spine surgery. It was the best decision I every made. When I got out of bed the next day, I was virtually symptom free. My surgery, while consider major, is typically a one to two day hospital stay.
I can tell you that it does take a long time to heal, because you must do physical therapy to get the strength back into your muscles.
Has your current doctor suggestive doing physical therapy along with the steriod injection?

I am not familiar with Gulf Breeze, Florida--is it on the west coast by chance. (gulf breeze being from the gulf of mexico--west side of florida). If it is located by Tampa, than I would suggest you check out the Tampa General Hospital. Further south, you could check out Sarasota Memorial. Further south, I would skip Lee Memorial Hospital and go straight east to Miami. It would definately worth the drive. Further North, you could check out Gainsville. You could also go across Route 4 to Orlando Regional Medical Center (I think this is the old name).
Please let me know how you are doing.
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Last edited by shisslak; 11-13-2010 at 09:38 AM.

 
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Old 11-13-2010, 09:42 AM   #4
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Re: Need help understanding my MRI

hi jubilee, sorry you even HAVE to be posting here at all but we DO have some very knowledgable people here on spinal but mostly down in the very end of this forum in the "S" section in the spinal forum down there? this is just where the c spine stuff generally kinda ends up at? you just really DO have some sirgnificant findings that ARE impacting into your cord level, and that in most cases, DOES also require some level of surgical intervention to just decompress that impact OFF the cord before real significant damage gets done.

from what i saw at the very end of one sentence listed in your c spine level MRI, its states that your cord has NOT turned 'malacic'? and that IS a really GOOD finding considering what you just have since that is short for something called myelomalacia? this is an actual softening or granualizing of the cord from TOO much direct compression into or on that cord and that is what really would tell alot how damaged that cord actually just IS itself, so thats a good thing to read there, trust me. this just needs decompressing BEFORE myelomalacia can set in, which is basically some level of real neural tissue death from lack of CSF being able to keep it bathed and healthy along with certain 'inner flow" within the cord too. along with blocking certain signals from doing what they just 'do" in our cords in carrying very crucial signals too and from the brain via the many different 'tracts" within our cords?

it really does appear just given the cord impact among other things here could very easily be responsible for your ongoing symptoms too. since the level of impact is simply THAT high up in the cord itself, it can very easliy produsce symptoms pretty much anyplace from that impact level on down for you. its just how this crap actually 'is". but you also appear to have at least "some' very direct nerve root involvement there as well in the c spine too. this all would/should be taken care of by the neurosurgeon when he relieves that pressure off your cord too.

exactly what was your 'injury' and what exactly occured to even do this? have you seen a good neurosuregon to discuss these findings and have a very thorough type of hands on neuro eval too(that hands on that the NS does really can tell ALOT)? that really IS what needs to be done here next, that referral to a good neurosurgeon since this WILL unfortuently require lifting of that compressed cord area before anything more could simply 'happen" to it and possibly make that MORE impacted into your spinal cord? your c spine where that area just is right now is a very vulnerable area. trust me here hon, i was in and to some degree, still in this very same posistion from something different than 'injury". but getting to a good neurosurgeon right now truely IS what NEEDS to be done as soon as possible when it comes to cord being directly impacted like yours is. getting into see an NS really just IS your very main priority right now hon. sorry to have to tell ya this stuff, but i am sure from seeing that MRI, you were already aware with some level of real cord impact, the results were NOT at all something you really wanted or needed to have going on in your life right now. but it CAN be dealt with and thats the more important thing here for you right now.

who exactly ordered this MRI to be done, your primary or some other type of doc? has ANYONE at all yet explained this report to you or is that why you came here? just DO get moving on getting that referral as early on now as possible since unfortuently most specialists simply DO take a while to even get in to see? but do pop into that spinal board hon and see what other opinions you can obtain there too? we just really do have some very knowledgable folks here who learned what they, and i know from having to go thru our own real experiences with the spinal or actual cord damage too. you did come to a really great and caring place for info and support hon. jenny really is a very helpful and knowledgable person as far as spinal goes too. she will see this post, i will make sure she does, lol, K? FB


sorry some of this IS repetitive from brendas post above? we must have been posting at the very same time. it just take me a wee bit longer these days.
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Last edited by feelbad; 11-13-2010 at 09:48 AM.

 
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Old 11-13-2010, 02:54 PM   #5
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Re: Need help understanding my MRI

Hi Jubilee,
I worked for 6 orthopedic surgeons for several years. I am NOT a medical doctor but I have seen the same findings many times. My first question to you is Who ordered the MRI? I am hoping it was, in fact, an Orthopedics physician- preferrably a Cervical & Spine Specialist. The first thing you should do is make an appt with one of these specialist and be sure to take both your films & reports with you. Doctors tend to forget at times that just because they understand all the terminology--that does not mean patients do! Ask your doctor to explain it to you in "Child's Terms"....((that way they will remember to be as simple as possible & NOT begin to ramble on)). Then ask them to draw you a simple diagram ((they can draw it right on the exam room table paper!!)).
You needn't worry yourself by trying to translate the MRI....it is the physician who can best explain it you.
From what I've read, it sounds like you probably have 1 or more herniated disks. Each of the vertebrae in your spine are cushioned by these disks. They are basically 'shock absorbers' ((Picture a truck driving over a speedbump -- the shocks allow the wheels a minimal amt of space to go up,over, & back down while the rest of the truck remains at the same height--or is supposed too )) If one of these disks becomes injured and breaks open, and the gel inside ((think lubricant for the truck hinges or shocks)) leaks out. Then the disk becomes fragile and breaks. If even a tiny fragment of the disk presses on a nerve---it might cause mild to more agressive pain and numbness. Depending on what nerve is being pressed will decide where the numbness leads too...often down the leg.
The epidural you mentioned...which one is it? If it is a LESI (Lumbar Epidural Steroid Injection) then I would recommend you ask for a TFE (Transforaminal Injection). It is simply a different approach to where the medication is injected at, but this can also lead to a different region. Sometimes it takes 3 or 4 of these injections to see any relief. The only setback is that they may only give relief for a couple of weeks.
Another idea for you is to google large hospitals that employ Spine Specialist and check out their website. Often they will offer explanations for problems such as yours and explain options to correct it. They will also have videos and blogs of patients which is always a plus.
But no matter what --- YOU know what you are feeling better than anybody out there...so don't ever sit back during your doctor visits....let them know exactly what you are feeling and ask every question possible. The more adamant you are about finding a solution to your problem, the more adamant they will be to find it for you
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Old 11-13-2010, 03:36 PM   #6
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Re: Need help understanding my MRI

Thank you all so much for explaining all this to me. My biggest problem is that this in a work injury. Everything is being covered under workers comp. They are so very slow. I was a cashier for a well known grocery store chain in the South. We are a beach store so we sell a lot of cases of beer and cases of water. Constant pulling of these through my register is what caused this. We don't have 'hand wands' to reach out so everything goes through the register. We also don't always have a bagger so we're pulling, pushing and picking up to bag things. It was the repetitiveness of this that caused my pain. I was never injured before and never had any pain in my back or neck before. The dr. that work sent me to at first said I had pulled muscles (my back and neck was swollen) and gave direct shots into the muscles to try to relieve the swelling. Pain pills and muscle relaxers with physical therapy for 4 months. It got some better after physical therapy and they decided to put me back on the job for 2 weeks to see how I would do. I couldn't do it...I'd end up in so much pain after a couple of hours of trying that I'd be in tears and barely able to stand or walk. They'd send me home. I'd return to the doctor and they just didn't know what to do. Finally workers comp said I needed an MRI so they sent me there and after the results sent me to a pain management dr. He is the one that is giving the epidural shots. He has told me that if these shots don't work for me then he'd have to suggest a surgeon. He said that would be my only option left. I have spoken to my regular family physician about what is going on. He says I need surgery. He knows this is workers comp and says things will be slow and they will try to wiggle out of surgery but with the numbness going on it will be inevitible. I wonder if me being diabetic would make for more complications? I am not on insulin but I am on oral medications for diabetes. Could this be a problem for me healing? Can a herniated disc that is pressing on nerves heal on it's own? Without surgery? I don't know much about all this as workers comp would love to keep me in the dark so they can 'play' with things to avoid paying for a surgery. This is why I seek advice here. I need to know from non-biased and knowledgable people what is going on. I am a 49 yr old female. I've never had children..never had any type of surgery and I'm scared. I don't know if I'm doing the right thing by just going along with whatever the workers comp doctors tell me. I have no private insurance and have to pay my private family physician out of pocket to see him and with very little pay now for only being able to work 4 hours a day twice a week doing demo work for the same grocery store to keep me off disability from workers comp (again, workers comp doctors under pressure to keep me working at anything I can possible do to avoid disablity payments to me). I can't afford to seek independant care outside workers comp. Any advice within my reasons is so very gratefully appreciated. Thank you all for responding to me. You've helped me to understand a lot!
To shisslak- Gulf Breeze is in NW Florida near Pensacola. Andrews Institute is a very good Orthopedic Hospital located here in Gulf Breeze but I don't know if workers comp would send me there or somewhere else.

 
Old 11-13-2010, 08:28 PM   #7
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Re: Need help understanding my MRI

jubilee1

Well w/c is another whole problem. Here in Massachusetts you can actually get an attorney to represent you in a w/c case and not pay for the representation. When you filed your claim, did the w/c carrier send you a booklet with all of your rights? Have you been assigned a w/c nurse to oversee your care? Check out the yellow pages and see if you locate attorneys that specialize in w/c cases. Some will review your case for free, they can also advise you on your rights. Are you a member of a labor union. If I remember correctly, Florida does not have many labor unions for its workers. If you are a member of a union, than get the union to help you out in getting the proper treatment.
When you go back for your next steroid injection, tell this doctor that the first one really did not work. Ask this doctor to explain whether this is something that is expected and how many shots will you need before you feel relief? Tell him that you are not real comfortable with this treatment plan and request that he/she refer you to a neurosurgeon who specializes in spine surgery. (or an orthopedic spine doctor--some people like ortho spine doctors where others, myself included prefer neurosurgeon.)
You will have to fight for everything, however, if you can find out the nurse case manager assigned to your case, then you can call her/him directly and request their approval for a neurosurgeon or ortho spine doctor for a consultation. Explain to her/him that from what you understand, the longer you wait for the surgery that most likely will have to be done, the longer you will be disabled, which mean they will end up spending more money for your care vs less. (talking money and how you could possibly save them some will hopefully get you what you need.)
In terms of diabetes, well, I think because you are controlled with medication vs insulin, I think you are at less risk than for someone who is uncontrolled and insulin dependent. It is still important information especially if you end up needing surgery, because the members of the OR staff will need to monitor your sugar levels during and post surgery. Sometimes healing takes a little bit longer also, so you might need special wound care instructions.
(Being nosy now--is it Publix, Albertsons or Shop and Save?
Let me know how you make out?
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Old 11-14-2010, 02:43 PM   #8
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Re: Need help understanding my MRI

HI Jubilee.....Marcia(Feelbad) asked me to come over and give you one of my handy-dandy anatomy lessons so you can understand what on earth is going on in your neck.

Let's start with some terms. Spondlylosis is basically saying you have arthritis in your neck bones. What does that do? It causes bone spurs to build in some places and bone to erode(disappear) in others and in some cases, thicken. Scoliosis is a side ways curvature of the spine(as you look at the spine from the back) that you are usually born with. It seems to be mild in both the neck and thoracic areas. That slight scoliosis probably started the arthritis.

The spinal cord leaves your brain and descends down through the spinal canal. It is covered by a lining that hold spinal fluid in around the cord called the thecal sac. The spinal canal is inside the bone of the vertebrae closest to the back of your spine. Gives it great coverage from injury. The front side of the vertebrae has a disk in between each vertebra to cushion them from shock from up and down(bending over and back up and all the stresses we but on our backs). Think of the disk as being like a donut......it is round and has a squishy center under a much harder exterior(a stale donut). As we age, that hard outside of the disk get brittle(a really stale donut) and is prone to breaking open and the inside stuff squishes out(extrusion). Only unlike a real donut, this stuff is much harder and gets in the way and pushes on nerves. Put that together with the arthritis and it's bone spurs and erosions, you get "an extrusion complex" in that it is mixed together with the other problems and no can tell what is causing what.

At each vertebra, a pair of spinal nerves peels off the spinal cord like a banana being peeled. They exit to either side of the vertebra through holes called foramina. If the disk contents and/or arthritis get in the way and press on those nerves, they call it impingement and it gets graded as minimal, mild, moderate, severe and obliterated(yikes). Your involvement of the spinal nerves seems to be limited so I guess that is a way of saying minimal to mild. That is good but it still hurts. Spinal nerves feel pain.

This disk goop got all the way into your spinal canal where your spinal cord is. It has pushed up against that lining covering the cord(thecal sac) and is actually pressing directly on your spinal cord itself. Luckily, the MRI showed no damage from that pressure. The most telling stat is the width of your spinal canal where that pressure is. It is 7.5mms. The normal canal is 12mms....but that includes the sac and fluid and just space around the entire thing. So it has filled up a lot of the canal to the point where there is very little room left for your cord and you may be having systemic symptoms from it.

What are systemic symptoms? Your spinal cord is made up of all those spinal nerves that peel off at each level so way up at C4-5, you have most of your body nerves still on the cord so you can have symptoms almost anywhere. You might have numbness in your toes, stiff leg muscles, trouble walking, you might have trouble holding your bladder or bowels. It all depends on how much pressure there is on those nerves. And since your arms are even below that level, you will have numbness and pain and trouble using your arms. You might drop things a lot as the muscles don't work right. Any sound familiar?

So how is it corrected? Surgery, unfortunately. They do a pretty common surgery called an ACDF(anterior discectomy and cervical fusion). They go in from the front of you neck and remove the bad disk(using a microscope) then to keep the bones stable, insert some bone and plates and screw the entire thing together. Once the bone grows together, is now fused. You are probably looking at having C4-5-6 fused together. The good news is, it's very common and with a high rate of success. There is a newer surgery called a laminoplasty that doesn't use fusion and if they do it at that hospital, you might be a prime candidate. I had it on C3-4-5-6-7 and it was great. All numbness and pain gone after surgery and I was back to work in 2 1/2 weeks. But it has a higher rate of complications than the traditional surgery and I eventually ended up being fused from C3 to T1. I think it was just too big of an area for this new surgery but with only 3 vertebra involved, you might be better.

As for insurance. WC may end up paying for part of the surgery and your insurance the rest. You had the arthritis and the scoliosis prior to this injury. The MRI even stated that they could not determine just how old the disk protrusion was and if it was new or old. What may be new is the amount of the squishy stuff that came out of the bad disk. It may have spread more and is now causing bigger problems. It will depend on whether or not your state has a "take them as you find them" law for WC. That means they can't take your past health problems into consideration and they have to fix you no matter what was wrong before.

You asked if a herniated disk can heal and the answer is no. Once the jelly is out of the donut, you can't get it back in. But sometimes it does shrink in size and move out of the way....it is sioft. So some people do get relief after while. If you've ever squeezed a jelly donut and then let it sit and get stale, the liquid in the jelly evaporates and the jelly shrinks in size and its the same here. But with the amount of space it has taken up in the spinal canal, I don't think it could ever shrink back enough to to completely take the pressure off of your cord. And that is your main problem.

WC and your insurance can work together to cover the costs. Do you have other medical insurance? Let's hope for the "take them as you find them" clause!

Get the second epidural shot and see what happens. Most docs(and insurance companies...not just WC) insist you try them before they will do any surgery. But with a canal at 7.5mms, I don't think anyone will give you a hard time getting surgery.

So here is the bottom line with spines. When your spinal cord is compressed to smaller than it should be, it puts you at risk of losing the blood supply to your spinal cord and that causes complete paralysis from that level down....neck down for C4. It's only like a 3% chance but it is still there. So they operate to remove the pressure. Oddly enough, what causes the pain is pressure on the spinal Nerves...those that peel off. They feel pain when anything touches them and the spinal Cord does not. So your pain has nothing to do with what the real problem is. I had this same problem(but I was at 6mms.) at C3,4,5,6and 7 and I had NO pain. It was all cord problems. Thank those other painful nerves for letting you know you have a bigger problem.

And that is what your docs are concerned about...not pain, but the muscle and nerve problems from that pressure. They can tell by reflexes and what you report are muscle problems...the way you walk, the numbness, dropping things....your arms and legs just don't work like they used to.

I hope this helps to explain what is going on. Ask all you want ....I am good with donuts!

Jenny

 
Old 12-03-2010, 11:47 PM   #9
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Re: Need help understanding my MRI

Your welcome
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