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Old 11-06-2010, 01:25 PM   #1
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Translating cervical spine MRI results

All,

Please help me translate the following into "english". I am having significant problems with the cervical spine but need help to understand the MRI report and whether or not I should consider speaking with a physiatrist, neurosurgeon, orthopaedic doctor or all of the above? Can anyone help me determine the severity of the report? Thank you so much!

IMPRESSION:
Large disk ridge complex at C5/6, resulting in severe spinal stenosis and obliteration of the left neural foramen. Moderate right-sided neural foraminal narrowing is also seen at this level. No evidence of cord compression.

At the C6/7 level, there is a moderate-sized disk ridge complex effacing the ventral thecal sac, resulting in moderate spinal canal stenosis. There is mild bilateral foraminal stenosis.

At the C4/5 level, there is a mild disk ridge complex flattening the ventral thecal sac, however, there is no spinal canal or foraminal stenosis.

At the C3/4 level, there is a mild disk ridge complex effacing the ventral thecal sac, however, there is no spinal canal or foraminal stenosis.

 
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Old 11-06-2010, 07:36 PM   #2
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Re: Translating cervical spine MRI results

You need a spine surgeon. I assume from this report you have a lot of numbness in your left arm going down into your left index finger and thumb? And I bet they don't work too well either.

Some interpretation....let's start with an anatomy lesson.

The spinal cord exits the brain and comes down through the spinal canal inside of the vertebrae. It is encased in the "thecal sac" that holds spinal fluid around it. At each vertebra, a pair of spinal nerves peels off like a banana and leaves the vertebra by holes called the neural foramina(one on each side of the vertebra). In between each vertebra is a disc that is made up of spongy material that acts as a cushion between the vertebra. The discs can rupture and the spongy material can end up oozing out and hitting the nerves or the spinal cord or the spinal cord sac or covering up the hole where the nerves exit. Arthritis can develop as well and that causes bone spurs to develop and the can do the same thing as the disc material and often you get a mix of bone spurs and and extruded disc material. This what they mean by a disc/ridge complex.

When they look for the openings for the nerves and how open they are, they grade the amount of opening as minimal, mild, moderate, severe and obliterated. We rarely see obliterated. It means that the spinal nerve leaving your spinal cord on the left side and going out to the body is no longer seen...it may be dead or almost dead. You are on the verge of paralysis with that nerve. That is what is at C5-6. Luckily, it is only at a moderate level on the right side. But the spinal canal is so tight it is a danger to your spinal cord(severe stenosis). Again, luckily, there is no signs of actually damage to or even anything touching, your spinal cord itself.

At C6-7, you have the same problem but it is only a moderate. It is touching that sac that surrounds the spinal cord and is moderately filling up the spinal canal. The holes on the sides for the nerves are only mildly closed up.

At C4-5, you have the same thing but at a mild stage. It too is touching the sac around the cord but is not filling up the spinal canal and it is not pressing/ filling up the holes where the nerves exit. Same thing at C3-4 but with even less of it pressing on anything.

Bottom line, you have a major problem at C5-6 and C6-7 is not much better. But with the term "obliterated", you are facing permanent nerve damage in your left arm if you don't do something to alleviate that pressure on the nerve. The disc/ridge complex doesn't just block the hole, it presses on the nerve as it blocks it. If it presses long enough and hard enough it cuts off the blood supply and the nerve is dead, permanently.

You need to see a spine surgeon, ortho or neurosurgeon. I prefer neurosurgeons but some like orthos. I think it's a question of availability too. But it's important that you find someone who does spine surgery 24/7/365 and not a neurosurgeon who does both brain and spine and if that means an ortho spine surgeon, do it. But again, they must do it all the time. Part time spine surgeons do a lousy job. This is one time when the quality of your doc translates into the quality of the job he/she does. You want the best doc you can afford and if you have to travel to see one, then travel. It may be the difference between being able to work and have a life of no pain or spending the rest of your life in pain and on disability. I kid you not.This board is filled with people who had docs they thought were good....until after surgery. Reputation counts here.

I know this sounds scary but everyone here is facing or has faced similar stuff. You can read lots of accounts of surgery and recovery and all sorts of things that can help. And we are here for support and questions.

So you must have questions.....ask away.

Jenny

 
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Old 11-07-2010, 08:17 AM   #3
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Re: Translating cervical spine MRI results

Thank you so much Jenny! I am shocked by the condition and the situation I am facing. Its interesting that I still have feeling in my left arm and hand and I still have strength as well. However 5 years ago I had severe pain in the left arm, shoulder, and hand. In fact I had atrophy and weakness - couldnt pick anything up at the time. I had a cortizone injection at that time and then I had therapy and went to the gym constantly for 3-4 years and my pain disappeared. But now it came back in a different form. Severe pain turning neck especially to left, trouble swallowing, tingling and strange hollow feeling in left neck to head area, headaches, and sometimes dizziness or blurred vision. I also have pain in left foot but doctor said this is something else.

You are right I have many questions... to start -

1) If the nerve is dead would I still have any feeling on left side?
2) If the nerve is dead, perhaps that is why I don't have the pain down left arm this time? But then again why do I have full feeling still?
3) Where can I find the MVP Player list of top Neurosurgeons? I live in NY City and have CIGNA Open Access coverage which is great but I don't know where or how to find the BEST one. My internist and medical group are wonderful but they are not the any kind of authority on neurosurgery.
4) Has anyone heard of Hospital for Special Surgery in NYC? I hear they are very good.
5) How fast should I get surgery. This week? or take time to find the best doctor and have a few consultations first?
6) How long is the recovery and how long are you usually out of work for this type of procedure?

Thanks for all the help. It was very comforting to see your response when I awoke this morning!

Ren

 
Old 11-07-2010, 12:25 PM   #4
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Re: Translating cervical spine MRI results

I'm glad to hear that you still have feeling and movement in that arm and hand. That is good. Means the nerve isn't dead but from the MRI, it is in grave danger of that happening. But the rest of your symptoms are classic for the problems you've got.

If the nerve were dead your index finger and thumb would not work...no grasp, nothing. But they can check the reflexes in that area and see just how bad it is.The strangest thing with these neck problems is that when the pain goes way, that is when they worry. That is a bad sign. You think you are getting better when in truth, you are worsening. And you foot pain may be your neck....you won't know until they fix it.

HSS is good and I've seen one of the spine guys there and he was very nice...Dr. Sama. Camissa is the head of spine surgery but I understand he charges over and above what insurance pays. Someone said Sama had left but I don't know. He sent me back to Boston. You can check their site. But they are all orthopedic docs. But it is the best ortho hospital in the world. One other I saw there was not so nice...Fisher.

New York/Presbyterian(the one up by the GW bridge...Columbia-Presbyterian?) has some neuro spine docs who I know are doing some of the latest surgeries so you could check there as well. Know a spine doc here in Hartford who was trained there and highly recommended it.

The key seems to be a spine doc at a teaching hospital associated with a med school and you have several in NYC. I'll put out a thread on docs in NYC and see who has seen who.

You have time...don't rush. But guard your neck. Looking upward is the number way to hurt it in this condition. No star gazing.

Recovery depends on the surgery they do. If they do one of the newest surgeries like a laminoplasty, you could be back at work in 2-3 weeks. If they do an ACDF(Anterior Discectomy and Cervical Fusion) you are probably looking at 4-6 weeks. It all depends on the choice they and you make.

So lets put out and APB on NYC spine surgeons and see what we get.

Jenny

PS...I'm fused from C3 to T1

 
Old 11-07-2010, 08:35 PM   #5
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Re: Translating cervical spine MRI results

Thank you so much Jenny!

Wow. C3-T1!!! And how do you feel now? Are you mobile?

Thanks for helping with the APB and the recommendations on doctors!

All my best,
Ren

 
Old 11-08-2010, 02:49 PM   #6
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Re: Translating cervical spine MRI results

Renster....I just read your posts and you have the best person with Jenny helping you. She is amazing. She helps everyone on these boards!!!!

I hope you will find a good Neurosurgeon in NYC. I saw the post earlier with Jenny asking for names of some goods surgeons there.

I live in Michigan and her and Sammy01 have been helping me. I have been on these boards for a while now. I have chronic pain in my neck and it certainly is not easy to live with.

I hope you find the help you need. We will be thinking about you and will be following your posts.

Take care of yourself.

Lyn AngelinMichigan

 
Old 11-08-2010, 07:06 PM   #7
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Re: Translating cervical spine MRI results

Well, today I spent most of day on the phone with Insurance Company reps, physician referral services, and came up with some amazing prospects however I am quickly learning that getting some of the A Team players to see you is all about who you know. I spent 20 minutes trying to get an appt with this one doctor and his secretary was impossible to deal with. "Fill out 7 pages of questions, send us your id card copied both sides, and your MRI results. We will have a scheduling coordinator call you after that to see what is available to see the doctor" When I asked what the schedule looked like in advance I was told to follow the instructions and that she has no insight to the calendar. Unbelievable!

Later in the day my primary care doctor called and said I should see the Physiatrist in his Medical Group first as sometimes the MRI staff can be a bit dramatic with their reports and it is good to get a consultation from the physiatrist before jumping to a neurosurgeon.

I have also learned that there are Orthopaedic surgeons for the spine and Neurosurgeons. I have also learned that neurosurgeons sometimes ask you to see a neurologist first.

So, I am waiting to get an appointment with the Physiatrist while I continue to research neurosurgeons.

Meanwhile I am sitting here tonight realizing that I didn't accomplish anything at work today with all the phone calls and research.

The other interesting experience is hearing everyone's ideas after you start socializing the issue. Everyone has an opinion. Don't get surgery. Get surgery. See a chiropracter. Do some Yoga. Swimming is good. Get a second opinion. Get a third opinion.

You start to feel like a pinball in the machine after awhile.

Thanks for listening... a bit frustrated right now.

Cheers,
Ren



Quote:
Originally Posted by ANGELINMICHIGAN View Post
Renster....I just read your posts and you have the best person with Jenny helping you. She is amazing. She helps everyone on these boards!!!!

I hope you will find a good Neurosurgeon in NYC. I saw the post earlier with Jenny asking for names of some goods surgeons there.

I live in Michigan and her and Sammy01 have been helping me. I have been on these boards for a while now. I have chronic pain in my neck and it certainly is not easy to live with.

I hope you find the help you need. We will be thinking about you and will be following your posts.

Take care of yourself.

Lyn AngelinMichigan
Quote:
Originally Posted by ANGELINMICHIGAN View Post
Renster....I just read your posts and you have the best person with Jenny helping you. She is amazing. She helps everyone on these boards!!!!

I hope you will find a good Neurosurgeon in NYC. I saw the post earlier with Jenny asking for names of some goods surgeons there.

I live in Michigan and her and Sammy01 have been helping me. I have been on these boards for a while now. I have chronic pain in my neck and it certainly is not easy to live with.

I hope you find the help you need. We will be thinking about you and will be following your posts.

Take care of yourself.

Lyn AngelinMichigan

 
Old 11-08-2010, 07:33 PM   #8
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Re: Translating cervical spine MRI results

Yeah, everyone has an opinion but none of them have your neck. I've been there. And so have a few others here. Never have a chiropractor work on your neck when you have problems...you risk paralysis and stroke. One part of the anatomy class I left out is that the main arteries to the back of your brain run through the top 6 vertebrae in your neck. If you have a bone spur in the wrong place and they do a manipulation they can cause a stoppage of the blood flow to the brain and you stroke out. Just became law here in CT to advise all patients with cervical problems of the risk of stroke prior to treatment.

As for getting in to a spine doc. What they told you over the phone is fairly standard. Your doc sends in the reports and a description of the findings and the MRI reports and then the doc looks at it and decides of you need to be seen sooner or later. Use the physiatrist to help you get in to someone.

My own doc takes usually 6 months for a new patient to get in. My neurologist sent in everything and I was seen in 3 weeks....surgery 4 weeks later. If they see something they don't like then they make room for you. Triage. Gets the ones with bad problems in and those who can wait, wait. I broke my neck 3 months after surgery while my doc was on vacation and once he was back, I was in the first day and in surgery the next week(didn't know it was broken until the day of surgery but he knew I was in big trouble).

Pebble Beach left you some good names on the thread I started looking for NYC spine surgeons.

And yes, they come in ortho and neuro. Hosp. for Special Surgery is all ortho. I have a neurosurgeon but some here have found excellent orthos and others found excellent neuros. The key is that they be full time spine surgeons at great facilities. BTW, Hosp for Special Surgery is rated the #1 ortho hospital in US News and World Report.

See your physiatrist and get his help on getting the best doc and getting everything in to whoever you decide to see.

Welcome to the world of the "super specialist".

Jen

PS...my maiden name is one all New Yorkers know...Riker....direct descendant. Wish I owned that piece of property! I'd be richer than Trump!

 
Old 11-11-2010, 08:21 AM   #9
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Re: Translating cervical spine MRI results

Renster....How is everything going? I have been thinking about you. Have you found anyone to see yet?

I know it can be totally frustrating and scary. You just want to make sure you see the right person and yes who is the right doctor!!! I have been through it all for years. I don't want to give you any advice right now because I don't believe in scaring somebody when they are not sure what is going on.

I do believe if someone has recommended you to a surgeon that they have used and they have had a good outcome or he is a well known surgeon that as Jenny says is a full time surgeon that does nothing but these surgerys then that is a good recomendation also.

Please keep in touch and just know that we wish you well and if you have any questions, there are lots of us here on these health boards to answer any of them or just to be here for you if you need us.

Take care Ren.

Lyn AngelinMichigan


Anterior Fusion of Cervical Spine on C5/6 6/7

 
Old 11-13-2010, 09:34 AM   #10
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Re: Translating cervical spine MRI results

Renster

How are you doing? I am concerned if you got any of the help you needed. Can you just please send a short note!!!

Thanks Lyn

Angel in Michigan

 
Old 11-13-2010, 10:57 AM   #11
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Re: Translating cervical spine MRI results

renstar,

My primary care doctor sent me to a neurologist first, because the thought was that I had MS. Well after see the neurologist and having an MRI of my head and visual invoke studies done, it was pretty clear that I did not have MS. My neurologist that requested that I have an MRI of my neck, she also had her office schedule an appointment with the neurosurgeon who is located down the hall. At the hospital that I went to, they have a whole neuro/neurosurgeon clinic that get patients into the doctors quickly. I had my neck MRI completed on a Tuesday (two days after neuro appointment) and I was in seeing the Neurosurgeon on Thursday. I had surgery the following Tuesday. I did get quite a few opinions from family and friends. (I always listen to other opinions, however, I know my body and I knew that what I was doing was correct for me.) Some wanted me to slow down and get 2nd and 3rd opinions and while they were probably correct, that I should have sought out other opinions, I was miserable and really needed to get better, so I did what I thought in my mind was what was best for ME.
So my suggestion to you would be--What do you think is the best course for you? Call your primary care if you really think that you need to see a neurosurgeon and ask for his/her assistance in getting you an appointment. If you think seeing a neurologist is the better first step, than again request the assistance for getting a prompt appointment. I have no idea what a Physiatrist is--maybe you can tell me what kind of doctor this is and how this person's opinion fits into the equation?
Please let me know how you are doing.
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Old 11-13-2010, 12:53 PM   #12
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Re: Translating cervical spine MRI results

Hi Renster, FYI... I would say no to both swimming and yoga, per my situation, similar to yours, but not as severe. Swimming involves arm-over-head motion that can aggravate your condition... and any kind of yoga that I tried caused my hands to go dead. Be careful. I had ACDF C5-6 for stenosis and foraminal impingement on Nov 1... it took care of the stupid-numb left leg problem as well. I'm doing great. It was a good surgery for me. Find the best neurosurgeon you can... then listen to him. Good luck and Godspeed.

 
Old 11-14-2010, 08:47 AM   #13
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Re: Translating cervical spine MRI results

Hi LabGal......I hope you are doing well!!!!

When you say your "hands went dead" can you elaborate on that. I am also having problems with my arms and hands and the doctors don't seem to worry at all about them. As long as I can push and pull on the orthopedic surgeons arms and pull back on them he just tends to ignore that this problem exists and writes down on my reports that everything is perfect in that area (which makes me angry).
7 years ago I had an ACDF on C5/6 and 6/7 and they discovered that my 6/7 did not ever fuse and that I have arthritis and bone spurs and some anterolisthesis. Anyway my arms are very heavy on the left and right side and my hands go numb and tingly most of the time. Also the circulation in my feet is really bad and especially in the morning my feet are always cold to the touch and almost purple looking and also tingle a lot. The doctor doesn't think that has anything to do with the problems either in my cervical spine.

The more I read on here the more I think it does. I am in chronic pain in my neck and shoulders 24/7 and my arms ache constantly and as I said my fingers feel numb quite often but I can still use them!!!

Can you tell me how you felt before your operation, and you said yours went away after your surgery?

Thanks, take care....Lyn AngelinMichigan

PS....I don't know if Renster is coming back to these boards, it seems like he hasn't been around in a while....Hopefully he is getting the help he needs and will come back and update us!!!

 
Old 11-14-2010, 09:53 AM   #14
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Re: Translating cervical spine MRI results

My Primary Dr. sent me for an EMG/nerve test first as she was concerned about the numbness and tingling in my arm. The Neurologist does part of the test so you're seen by the Neurologist the same time usually. The Neurologist referred me to a Orthopedic Surgeon but I've had a consult with a Neurosurgeon also. Hope you're seen by a Spine Specialist soon.
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Old 11-14-2010, 01:31 PM   #15
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Re: Translating cervical spine MRI results

Hi AngelinMichigan. I am also from Michigan-Muskegon area. My symptoms prior to surgery were; a weak left arm and hand, shoulder, arm, face and head pain on the left side, and the dead hand thing. Which was basically I would wake up in the morning with hands that were swollen and numb (remember blood vessels also run through your cervical spine- so circulation can be affected by stenosis). I also could get the same effect of numbness and swelling if I used my hands in a sustained lateral position for more than a few minutes (eg playing flute, using the sewing machine). My neurosurgeon (and I recommend that you go to a good neurosurgeon, not an orthopedic guy for this) said that carpal-tunnel and the cervical spinal problems can mask each other and can aggravate each other, and that I may have both. I got good results from the surgery, especially on the left side, but still have some numbing with use of my right hand. What really helped my decision to go forward with this surgeon, is that he gave me an Aspen collar to play with prior to my decision for surgery (its the brace he put me in after the surgery). When I wore the brace at night my hands were normal in the morning, so I knew it was my neck. I also had foot and balance issues that they didn't think were related to this cervical spine, but they have resolved since the surgery. Pay attention to which fingers are going numb. The last three fingers of both my hands were affected, but not my index finger or thumb... which can indicate stenosis... or closing of the spine. I don't know the neurosurgeons in Michigan, but I found an excellent one in Orlando that I would recommend to anyone. I hope I answered some of your questions. Best of luck... and God bless.

 
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