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Old 08-03-2010, 04:00 PM   #1
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Thumbs down MRI of Cervical Spine--Help

I am in a horrible amount of pain down my arms. I work in the early childhood special education field. I have to sit behind little babies as they are being bounced on a therapy ball. When I hold my arms out and have the pressure of the child on my arms I feel so much pain that I feel like i'm going to drop them.

Here is what the results said:

C5-C6 intervertebral disc is decreased in height and with anterior endplates contacting each other, anteriorly directed osteophyte. A posterior left paracentral annular tear with a disc extrusion measuring approx 2-3 mm AP, 4-5 mm SI contacting and flattening the left ventrolateral surface of the cord with mild central canal narrowing. Left foraminal extension of disc bulge and osteophyte and uncinate process spurs with moderate bilateral neural foraminal narrowing. Mild bilateral facet joint.

1. Summary: Moderate C6-C5 and mild C3-C4, C4-C5 degenerative changes with a chronic left paracentral C5-C6 disc extrusion with foraminal stenosis, recommended clinical correlation for C6 Neural impingement.
2. Central canal stenosis: Asymmetric mild narrowing of C5-C6 central canal due to disc herniation as described without cord signal changes or cord compression.
3. Neural foraminal narrowing: Moderate bilateral C5-C6; and mild to moderate right C3-C4 neural forminal narrowing.
4. Facet joint arthrosis: Mild facet joint arthrosis at C5-C6 without significant inflammatory changes at any level.
5. Cord and vertebral bodies: Cervical cord demonstrates normal signal intensity without myelomalacia or a syrinx, no evidence of cord compression. no acute/subacute vertebral compression fracture or deformity. Craniovertebral junction is unremarkable.

I am being referred to a neurosurgen. My question is what does this mean? Is this serious or can it be treated by something.

I am in A LOT of pain/discomfort. Is this normal? If anyone else has had this much pain what kinda pain meds did you get if any.

I'm stressed

Belinda

Last edited by belemilus; 08-03-2010 at 04:02 PM.

 
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Old 08-03-2010, 06:45 PM   #2
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Re: MRI of Cervical Spine--Help

I'm not the best at MRI interpretation, but in general you do have some issues that would be resulting in your symptoms.

Anytime you have stenosis that means the area where a nerve is has narrowed. Stenosis can occur in anyone, especially as we age. The discs are squishy objects between the vertebrae and they are held together by a gelatinous membrane. When there is a herniation that means that the inner material has come through the membrane. Some people have small herniation and never know it as they have no symptoms. In your case it appears the herniation is such that it may be causing nerve irritation or impingement. That often results in symptoms such as numbness, tingling, searing nerve pain, and weakness of the arm/hand/legs all depending on the level.

Search for a spinal dermatome picture. It's a graphic representation of where we feel symptoms at which levels of the spine. You can compare your results from the MRI to see if that is where you are feeling the pain.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 08-03-2010, 07:41 PM   #3
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Re: MRI of Cervical Spine--Help

Hi Belemilus...SpineAZ asked me to come over and explain the MRI a little better. I kind of give anatomy lessons.

So you have this spine made up of vertebrae and in between each vertebra is a disk of material that is "squishy" and acts as a cushion for the bones. It had a tough covering but it can break down and let the squishy stuff out and it kind of oozes but is still pretty thick and hard even when out of it's covering. That is a herniated disk. You also get bone spurs all over the place just from normal aging. These are called osteophytes.

Down through the middle of the bones is a space for the spinal cord to go. The cord is oval shaped at the neck level. It is surrounded by a thick covering that contains spinal fluid. At each vertebra, a pair of spinal nerves peels off the cord like a peeling banana and goes out to the body. The hole in the bone where the nerves go out is called the foramina. It's when something presses on these spinal nerves that you get so much pain going down your arms. The spinal cord doesn't feel pain just like the brain doesn't so you don't feel when that is being compressed. And compression is expressed as minimal, mild, moderate, severe and occasionally, very severe.

So let's look at your summary.

1-you have moderate degeneration at C5-6 and mild above that. The worst degeneration is from a bad disk that had ruptured and has oozed out and has moderately blocked the nerves leaving for your arms. It is worse on the left. Degeneration is a fancy way of saying that you have arthritis and a bad disk and everything looks bad....or moderately bad and mildly bad above that.

2-again at C5-6, the disk that oozed out had also pushed up against the spinal cord. Reading further, it says it shows the cord is slightly indented but shows no signs of damage nor did they say the cord was smaller than it should be. So the cord is pushed up against but not indented or injured.

3-the hole where the nerves exit the bone are moderately closed up on both sides of C5-6 and mild to moderately closed up at C3-4, worse on the right. As was previously noted, the lower area was slightly worse on the left. Have to balance the misery you know

4-you have some mild arthritis of the facet joints. These are joints on the sides of the vertebrae that are involved with any kind of twisting motion. Probably hurts to turn your head.

5-the bones are okay...no fractures, the area where your spine joins your head is okay and the cord looks just fine. Some good news for once

You definitely have problems and I can see why your arms hurt so badly. But this can be fixed. I imagine the neurosurgeon will recommend that they do what we call here an ACDF....anterior cervical discectomy and fusion. They go in through the front of your neck with a microscope and remove the oozing disk, then to keep everything good, they fuse the 2 vertebrae together with screws and a plate. Whether he'll recommend doing just C5-6 or wants to include C3-4 and C4-5, I don't know but they are not bad yet and with all the new surgeries coming along, you might be fine with just doing the 1 level. At the same time, he can open up the holes where you have the compression on the nerves and clean up some of the arthrits and other problems as he finds them.

If you read some of the other posts, you'll see that lots of folks have this surgery and return to work just fine. But get the best spine doc you can. I usually recommend you get at least 2 opinions unless you really like and trust doc#1. It seems there is a direct correlation between the expertise of the surgeon and the outcome. Whether it's an orthopedic spine surgeon or neuro-spine surgeon, it should be someone who does nothing but spine surgery.

You do need surgery but it is pretty common these days so don't worry. It's not that bad. I've got 6 vertebrae fused and can do a lot of things I used to but I need to lie down more often. Can still pick up my 30 pound granddaughter. Did quit working but I also have rheumatoid arthritis and my doc was adamant that I do. I think you'll be just fine.

Any questions, we are here.

gentle hugs..........Jenny

 
Old 08-04-2010, 01:11 PM   #4
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Re: MRI of Cervical Spine--Help

I really appreciate you responding. I really thought I was going nuts when it comes to the pain I'm in.

I had the doctor (she is actually a nurse practictioner) humor me and do the MRI. She is refusing to give me pain meds. After the MRI came back instead of her calling me to tell me the results she had her nurse call and say that Physical therapy would probably help the numbness I'm feeling.

I told her "What numbness. I'm in pain." I still am not on any pain meds.

The neurosurgen did call to make an appointment though and it's not for 3 weeks.

In the meantime I need to figure out how to manage the pain that I'm in.
I mentioned that I work with babies... I am an early childhood special education teacher. I seriously am having trouble functioning. I have to carry bags into home visits, I hold these babies, support their backs while they are being bounced on a ball etc. Would this sort of thing be hard for someone with my issues?

This is a new doc/NP for me and I am so frustrated because I know for a fact that I'm hurting. I am not drug seeking.

The sad part is she wants to give me anaprox which I am taking but I can't take because I had gastric bypass.

Straight Tylenol does not work. Is it wrong to want Perocet for this? I feel just awful about this. It was by chance that I was even put on Percocet recently. She gave it to me for a migraine and I realized when I took it that it completely took away my arm pain.

I am looking forward to getting this fixed. If you have more information on how to handle this sort of pain I would greatly appreciate it. I know for a fact that I'm not a pain med seeker.

Someone please tell me if the injury I'm dealing with should be mild, or severely painful or not. I have nothing to compare this too. If this is a painful injury.... how might I go about handling this sort of doctor issue?

Thanks again

Belinda

 
Old 08-04-2010, 01:22 PM   #5
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Re: MRI of Cervical Spine--Help

You may want to see a good Pain Management physician. If after seeing the NS he recommends epidural steroid injections he may refer you to a PM physician. Have you called your doc to ask for 3 weeks worth of pain medications? Not sure if they'll comply but given the findings I can't see why they'd resist (though many doctors do as they don't believe in pain meds and/or fear prescribing them).
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 08-04-2010, 01:28 PM   #6
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Re: MRI of Cervical Spine--Help

It's such a horrible feeling to think I have to ask for pain meds. I hate it. I asked her for the number of a pain management clinic so I'm going to call, but I don't know if It's worth it for me to try to get into to see them before I see the NS. I would like to get some relief though. I just really want to be able to do my job.

Do you know if my issues would cause a lot of pain? Or am I nuts...lol

Belinda

 
Old 08-04-2010, 01:57 PM   #7
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Re: MRI of Cervical Spine--Help

Yes, the issues you have can cause significant pain in your neck and possibly nerve pain extending down the arms (I describe nerve pain as "searing"). Sometimes OTC anti-inflammatories such as aspirin, ibuprofen (advil), or naproxen (aleve) can help a bit. But often additional prescription pain meds are needed to control as well.

If you look at a spine dermatome picture or chart you will see on a picture where pain typically is felt for each of the different levels.

For example, my current problem is nerve pain in the shoulder and biceps and this is common with C4 nerve impingement or irritation. This is consistent with my MRI and x-ray findings. I have C6 related pain as well which is also substantiated by my test results.

When I was still working I would take OTC meds during the day and pain meds when I got home. Eventually I was taking pain meds during the day.

There are 2 types (in general). The first is short acting meds like percocet, vicodin, etc. Then there are Long Acting (LA) such as Opana ER, Kadian, MS contin, etc.

Often a combination of one or more of those works and a muscle relaxer can help as well. Personally, when ever I have pain I tense up my neck muscles plus they spasm a bit due to the nerve impingement. So muscle relaxers have always been key to me doing ok. One of the most common is Flexeril (which is available as a generic).


Don't let my surgical history scare you as I've had life long problems with lax ligaments and tendons which has affected joints all over my body.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 08-04-2010, 02:03 PM   #8
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Re: MRI of Cervical Spine--Help

I made an appointment with a pain management clinic but it won't be for another 2 weeks. I'm not sure where to go from here. I just need some relief. Thank you so much for your help again.

Belinda

 
Old 08-04-2010, 07:35 PM   #9
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Re: MRI of Cervical Spine--Help

Today while I was at physical therapy he was able to explain a bit more as to what is happening.

I have NO idea if traction was suppose to help, but I'm thinking I left in more pain than when I walked in the door.

Does anyone here have experience with traction?

I made an appointment with the only pain clinic around. I've seen the facility before. They do just about everything there and have an aquatic component as well. They were able to get me in next week. My NP sent me to "their" pain person, but with the way I've been treated by her, I think I would rather have an objective person handling this.

I feel better already just knowing I have a plan. It's hard for me to advocate for myself especially when doctors are suppose to "know it all." Telling me in not so many words that I'm pain med seeking is humiliating. I walked out of there and cried. I can't just go write a prescription for myself so I'm at their mercy. It's a tough one.

None the less, I am grateful for all of you already. Belinda

Last edited by belemilus; 08-04-2010 at 07:37 PM.

 
Old 08-08-2010, 04:43 PM   #10
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Re: MRI of Cervical Spine--Help

hay i am new too, read my what would you do. but as far as pain meds go i do go to a pain management place and they told me that doctors have red flags when people ask for percocet or vicodin. as your doctor for a referral to a pain management place. I am on 30 mg morphine 3 times a day and 15mg up to 4 a day. but from what i have read nothing helps with forminal stenosis it will only get worse with time. i want to get off all pain meds and am hoping if surgery is warranted and it can fix me then they can wean me off in the hospital. ifelt like you a year ago wanting to be pain free but iam still in pain after a while the pain meds dont work anymore, so they have to keep increasing the dose and think about it is this what you want, for the withdrawls are quite intense and can even be life threatening. I started on vicodin for 4 months, 30, to 240 in the end then morpine now for 9 months.

 
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