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Old 08-11-2010, 01:10 PM   #1
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New - need help understanding my ct results.. chronic pain....help please?

Hi. I am new to the board and I am not sure if I am posting in the right place ( sorry if I am not ). I have suffered from chronic pain in my neck, right shoulder and right upper back for approximately 5 years. I am a 41 year old female who has one physically strenuous job and another mentally stressful job. I have gone to my family doctor on numurous occasions and to date he has sent me for an x ray ( 4 years ago which showed the beginning of arthritis in my neck ) and just recently after continually complaining has sent me for a ct scan which of course I can't understand. Other than the constant pain in my neck I have shooting pains down my right arm into my elbow, numbness and pins and needles in my hand and fingers. I suffer from headaches ( 3-4 in a week ) with at least one of the headaches turning into a major migraine ( with nausia, auras( sp?), dizziness, can't eat, can't lie down, can't stand up, light hurts ). I have tried massage therapy, chiro, accupuncture, migraine meds, anti inflammatories. All with no relief. I did go for nerve blocks for about 10 months which did provide me with limited relief however had to take morphine and ativan for me to be able to get the needles ( fear of needles ) and had a bad reaction to the morphine so have since stopped the nerve blocks. My doctor has finally referred me to a Pain Management clinic at a very reputable hospital and my appointment is finally near, August 24th. I recently requested the written report from my doctor in regards to the ct scan I have done as I had not heard from my doctor with any results. Can anyone help me with understanding some of the results??


It reads:

C2-3/C3-4 - demonstrates no significant disc disease, spinal canal or foraminal stenosis ( I undertand this )

C4-5 - posterior midline small disc protrusion indenting the anterior thecal sac with no significant spinal canal or foraminal stenosis ( ? )

C5-6 - moderate size posterior osteochondral bar formation indenting the anterior thecal sac and effacing the lateral recesses resulting in mild to moderate right and mild left foraminal stenosis (? )

C6-7 - small posterior osteochondral bar formation with mild bilateral foraminal stenosis ( ? )

C7-T1 - no significant spinal canal or foraminal stenosis. Assessment was slightly limited due to beam hardening from the patient's shoulders. ( ? )

IMPRESSION - Mild multilevel degenerative changes with more ponounced findings at the C5-6 level and to a lesser extent at the C6-7 level, as described above.

Any help will be appreciated. Thanks everyone.

 
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Old 08-11-2010, 01:45 PM   #2
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Re: New - need help understanding my ct results.. chronic pain....help please?

Time for some explanations of terms and some anatomy.

The spinal cord goes down through the vertebrae in your back and it is enclosed in a sac called the "thecal sac" that holds the spinal fluid in around the cord. At each vertebra, a pair of spinal nerves peels off the cord(kind of like a banana) and exits the vertebra at an opening called the foramina(foramina means "opening" even in other parts of the body). Stenosis means "closing up" or in this case, the foramina(openings) are closing up or the spinal canal that holds the cord is closing up in canal stenosis.

So, at C2-3 and 3-4, you are okay.

At C4-5 you have a small disk herniation that is indenting the thecal sac but not touching the cord. Nor are the spinal nerves touched or compressed. Spinal nerves when touched (or compressed) hurt...sometimes badly. The spinal cord does not hurt when touched but may show signs of not functioning right.

At C5-6 you have arthritis that has formed a "bar formation" like a line of bone spurs across the bone and it is indenting the thecal sac again but not hurting the cord. BUT, this time, it also is closing up the holes where the spinal nerves exit on both sides of the vertebra. The right side has mild to moderate compression and the left has mild. They grade the compression by minimal, mild, moderate, severe and very severe. By the time you get to moderate, you are in pain. And it should be noted that they tend to under rate these compressions...only a real neurological exam will tell you if it's bad or not by what you can feel and what your reflexes are doing and other tests of the nerves function.

At C6-7, you have another arthritic bar formation . It is not touching that thecal sac but it is pressing on those spinal nerves on both sides but is categorized as mild.

At C7-T1...they had trouble seeing it because your shoulders were in the way.

Bottom line, you have compression of the nerves leaving your spinal cord and into your arms at 2 levels. They are mild to moderate and should be making your hurt. Numbness and tingling may be a symptom too. Even though the bone spurs(osteochondral bar formations) are touching the sac that goes around your spinal cord, the cord is okay and even if they do, the cord can take a lot of compression before it needs surgery. And most docs will not operate until the nerve compression is in the severe range.

The reason they don't operate until you are really bad is that you risk causing more damage than you relieve.

An MRI would give you more info into how bad the problem is.

But there are things you can do with pain meds, muscle relaxers and physical therapy can help to strengthen the muscles and take some of the stress off the bone to lessen the arthritis. Acupuncture helps with neck pain.

There are lots of things you can do to help relieve the pain and hopefully you won't ever need surgery. I know others will be along to share their tips on how to relieve the pain.

Any questions, we are here.

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

 
Old 08-11-2010, 02:01 PM   #3
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Re: New - need help understanding my ct results.. chronic pain....help please?

Jenny........oh my.........thank you so very much. I can't tell you how much your post means to me!!!! I understand now thanks to you!!! My family doctor has been, let's say, less than helpful to me. I ask questions and all I get is.......there is nothing to be concerned with......he didn't even tell me the results of the ct scan...I had to call the office and request the written report on it....anyways, I go see the Pain Clinic for my initial assessment on the 24th and I really wanted to understand what the ct scan said so that I could have an informed discussion with the Doctor. Thank you again!!!! I hope to finally control some of the pain that I experience on a daily basis plus hopefully help my migraines. Thanks again. If anyone else has any experience in this area please share!!!!!!!!

 
Old 08-26-2010, 07:38 PM   #4
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Jennybyc help

Hey. You helped me last time so I would like to ask you another question.....I hope you don't mind.........so I went to a well respected pain clinic here ( waited 3 excrutiating painful months ) and have been told that if my pain is from my disk issue then there is no one in the world that can help me??? I am going to go for some diagnostic testing to see if possible nerve blocks into the faucett ( sp?? ) joints may work but they said maybe it will work, maybe not. And of course to go for the diagnostic testing I am 77th on the list and they only do it once a week so basically I am looking into next year. I was so sad, I felt beaten. I am a little better now but not sure what to do....I have an appt with my gp but he continually brushes off my constant pain. What do you think, or have you heard of what they told me about the bulging disk?? That no one can help??

Thanks. Sorry for rambling but I am at a loss, don't know where to turn and feel like the pain is never going to go away or even just get a little more tolerable.....thanks for listening.

LoraB

 
Old 08-27-2010, 11:50 AM   #5
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Re: New - need help understanding my ct results.. chronic pain....help please?

Well, they are right to some extent. A disk that has herniated and is pressing on the spinal nerves won't stop hurting until they remove the disk. No pain management doc will be able to help. Problem is, most spine docs won't operate until the compression is listed as "severe". The reason why is that they run the risk of doing more damage than they fix.

But the level where you have a herniated disk is not where you have spinal nerve compression. That is the level where the bone spurs are..that bar ridge across the vertebra at C5-6. You have bone spurs closing up the opening where the spinal nerve goes out to the body. And it's listed as "moderate" which means they won't operate until it gets worse.

But you also have a lot of arthritis in the facet joints...those are projections off the back of the vertebrae that act as joints to stabilize twisting motions of the neck. From personal experience...that can hurt as much or more than the compressed nerves. So wait and try what they can do for those joints. Usually they try injecting the joints with a numbing agent to see how much it helps. If it helps, then the use radio frequency waves to heat up and burn off the nerves in the joints. It can give you a lot of pain relief for 6 months to a year.

If you can get that pain down to manageable or no pain, then it will help you cope with the spinal nerve compression pain. Sooner or later, you'll probably need surgery to relieve the pressure on the spinal nerves and they can fuse the vertebrae and stop the facet pain too.

I know it is so frustrating to have all this pain and having to wait but it is what it is. Took my brother months to get a triple by-pass and even when put on the urgent list, still took 3 weeks....his main coronary artery was 98% blocked....and he had to wait 3 weeks! But we all have our own burdens to carry. Here in the US, if you don't have health insurance, you won't get the treatment unless you pay up front and that make take away options or take months to save up for. And even with insurance, there are still waits for approvals and lines at the clinics. My own doc takes 4-6 months to get in to see. Pain makes us impatient. It doesn't matter where you are or how your health system works....pain makes us want to feel better NOW. And it just doesn't happen. As for surgery, it may save a nerve from dying but there is a good chance you may be stuck with the pain even after surgery. Spine issues are tough.....as tough as anything you'll ever face.

So we do what we have to keep on going. Post here all you want. Vent...get it out of your system. Frustration makes pain worse. We all understand. You'll get help as soon as possible, I hope. But everyone here has been down the road you're going down and we all know...we all know the stats and what our futures look like. But we stay together and help each other and that makes it worth holding on and keep on going.

Ramble all you want.

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

 
Old 08-27-2010, 01:19 PM   #6
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Re: New - need help understanding my ct results.. chronic pain....help please?

Hi Jenny. Thanks so much for taking the time to get back to me. I see that you are a HUGE source of information for others on this board and I think everyone greatly appreciates what you do!!!!! So I wanted to say thank you......

I now understand what the pain specialist was trying to tell me. I asked lots of questions when I was there but unfortunately felt like I was getting a long winded answer with big words and even though I said a few times I didn't understand I kind of just walked out feeling I didn't get answers. It was very frustrating. And I totally know that there are people worse off than me ( God bless them ) and I know I have to wait my turn I'm ok with that. Since posting last time I decided to go back to physio and speak to my doctor about maybe something to help me sleep. I find that I don't sleep well and when I have a bad night I pay for it with neck/shoulder pain and migraines the next day. So hopefully some of this will help until I get into the clinic for the diagnostic testing. What you described with the burning of the nerves is what my gp sent me to the pain specialist for. So hopefully when its my turn it will work. I was just confused when he said that because they don't know if my pain is from the disk issue or not and if it turns out to be because of the disk then there is nothing that no one can do. I was a little confused at that one......anyways, sorry to vent and to go on and on......again thank you so very much. You are an angel!!!!!!!

 
Old 08-27-2010, 01:35 PM   #7
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Re: New - need help understanding my ct results.. chronic pain....help please?

Vent away my friend...that is why these boards exist. Pent up frustration and pain is so bad for all of us that it's wise to let it all out.

That is why we are here...we all need to from time to time.....including me.

And thank you for the compliment.

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

 
Old 08-27-2010, 02:38 PM   #8
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Re: New - need help understanding my ct results.. chronic pain....help please?

The Thecal Sac is the lining around the spinal cord. From what I'm seeing from your post is similar to what I had. Mine was diagnosed by MRI instead of CT. Also, I'm not a doctor, I have worked in diagnostic imaging for over 30 years and am used to reading radiologist reports.

Basically what the report is saying is that you have bone spurs pressing on your spinal cord and that the openings between the vertebra where the nerves to you arms go out from the spinal cord are narrowed putting pressure on the nerves, causing the pain.

First, I had similar findings on my MRI report. My pain was similar to what you describe in your post. Mine started with my right arm and later migrated to my left arm.

Second, I had tried everything possible trying to avoid surgery. None of which worked.

Third, I had ACDF (anterior cervical discectomy and fusion) surgery on May 3rd, 2010.

I can tell you that I was very apprehensive about the surgery. I had my initial consult with the Neurosurgeon in eary March and decided to wait for awhile before commiting to
surgery. I made it just over a month before I couldn't take the pain any longer.

As I said earlier, I had surgery on May 3rd. The pain relief was immediate for me. When I woke in the recovery room, the pain in my back, shoulders and arms was gone. I spent the night in the hospital, rode home in our car, (150 miles) the day after surgery.
I wore a soft c-collar for 2-3 weeks. I went back to work after 4 weeks. I am now almost 4 months post-op and feel pretty good for a 57 year old grandfather. I have had some pain return in the last few weeks, but it isn't anything like it was. I can pretty much do anything I want.

You should get a consult with a neurosurgeon. Check with other people who have used that doctor. You need to feel comfortable with the doctor and know that you can trust him/her. Listen to your body, it will tell you when you need to do something. Not everyone has the same experience/outcome, even from the same surgeon. From what I've seen, I may be more the exception than the norm but I would not hesitate to go through the surgery again for the pain relief I've gotten. "God heals, sometimes he uses the hands of a doctor to accomplish the healing".

 
Old 08-27-2010, 06:35 PM   #9
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Re: New - need help understanding my ct results.. chronic pain....help please?

Hi Poppa John and welcome to our fine little group. Glad to have someone else here to do the reading of MRI's and CT's. I've learned the hard way.

But make sure you look at where people live. LoraB is in Canada and working within the confines of the Canadian health care system can be a true exercise in frustration. I had a friend who was put on the knee replacement list on her first visit to the orthopedic surgeon knowing it would take about 5-7 YEARS to finally get her surgery.

Health care is there for all but you have to wait in line. Any consults have to come through your GP if he or she thinks it's warranted and if they don't, you don't go.

So sometimes suggestions just don't help and make frustration even harder to handle. That's when this place becomes so valuable...we can all vent here.

Like it or not, spine problems are a b@#$%!

Welcome and gentle hugs..........Jenny(fused C3 to T1)

 
Old 08-27-2010, 06:51 PM   #10
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Re: New - need help understanding my ct results.. chronic pain....help please?

Hi PoppaJohn. Thanks for your post. I definitely appreciate everyone's story. If for nothing else but to remind me I am not the only one ( as so often that is how I feel because my gp hasn't/doesn't really take my constant pain as seriously as I would like ). I am glad the surgery helped for you. I think any type of spine/back/neck surgery really really scares me. I wouldn't even have an epideral during both labours .....but I have come to realize that since I am only 41 and have 2 extremely stressful jobs ( one physically and one emotionally ) that at some point in my future I will most likely be looking at something like surgery. Right now in my life I would be slightly happy if someone actually took my pain seriously. Ok I guess although I told myself I wasn't going to rant...this may/is turning into one. Jenny was right, I am from Canada and wait lists are very long, which I understand. But to not be taken seriously by my gp has been and is extremely frustrating. And unfortunately with new rules in the health care industry I had to sign my life away to my gp. We were required to sign a contract with our gp saying that we will only see him and that if we choose to go to another doctor then we loose our right to stay with this gp. Thats not so bad but with the doctor shortage here no doctors are taking new patients. So I am stuck staying where I am . I should be clear that he did send me to the pain clinic after bugging and bugging and bugging. I will be going to see my gp next week to see what I can do in the mean time until I can get back into the clinic for some diagnostic testing but I am not sure he is going to be helpful. I would love a referral to a neurosurgeon, a rheumatoligist ( sorry on the spelling ) but I am pretty confident I won't get one. Ok my sincere apologies that this turned to a rant......it does feel good though to be able to say how I feel to someone who listens ( ok reads ).....thanks for listening and I will try not to rant anymore I would still love to hear from others who may be in a similar situation or similar pain and what has worked/helped.....thanks everyone......

And hugs back to Jenny!!!!!

 
Old 08-27-2010, 07:11 PM   #11
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Re: New - need help understanding my ct results.. chronic pain....help please?

LoraB and Jenny, sorry that I just jumped in there with my reply. I haven't been on the message board much since just after my surgery so I jumped without looking. LoraB, I can understand the frustration. I worked with a radiologist a few years ago who came to us from Canada. I heard many stories (from the physician viewpoint) about healthcare there. I do hope that you get some help from someone. Although I don't know first hand about your medical system, I do know from experience about your pain. I was working every day while taking the equivalent of morphine, muscle relaxers and antispasmotics and then taking sleeping pills at night just to try and rest so I could do it all over the next day.
Please don't apologize for venting. We've all done that. This is a good place to vent and most of the contacts I've had here gave me encouragement, understanding and let me know that I wasn't the only one in pain. You are not alone! Vent any time you feel like venting, otherwise you just internalize the feelings and frustration and that leads to bad things both physically and mentally.
Again, I am sorry about the earlier post. I will try to pay more attention to earlier posts and locales in the future.

 
Old 08-27-2010, 09:47 PM   #12
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Re: New - need help understanding my ct results.. chronic pain....help please?

loraB - your GP cant prescribe medications to make you more comfortable or to at least feel human?
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Old 08-28-2010, 08:56 AM   #13
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Re: New - need help understanding my ct results.. chronic pain....help please?

Lora....you'll do fine...you have a survivors spirit. And venting feels good, doesn't it. Please help yourself to all the venting you want! It's one thing we offer for free with no lines!

Poppa John...you should see where some posters are. The people in SE Asia where they've never heard of a neurosurgeon and only have a clinic a 20 mile walk away...that becomes hard to help them. I had one guy in the service in Afghanistan on patrol in the mountains with a computer but only a medic to help with a bad knee. Was giving him all sorts of ways to use what they had to do PT...rocks for weights wrapped in a duffle bag,....came up with all sorts of ways to help him until he could get back to care.

Takes some creativity and I bet you have a lot of that. Looking forward to you being a great resource for all of us.

And for everyone...nothing is more frustrating than not being taken seriously by the person who depend on to help you, be it GP or neurosurgeon or anyone in the medical profession. When they can't or won't help, it just makes everything hurt more. That's why boards like this help. It's friends who have been there who help when no one else seems to care. Sometimes they are life savers.

Take care everyone and gentle hugs to all..............Jenny

 
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