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Old 05-29-2011, 11:23 PM   #1
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Angry Need help understanding C-spine MRI~NOT cortisone shot

I am a healthy 50-year-old woman. I'm a massage therapist and I've had numbness and tingling in my right arm off and on for at least five years. Two weeks ago, after an overzealous bout of tree trimming, yard work and gardening I found myself in excruciating pain that has not subsided. I've had two MRI's, one on my shoulder and the other of my C-spine. The shoulder said I had joint degenerative change and rotator cuff tendinosis with a focal high-grade partial tear of the anterior distal supraspinatus tendon involving both the articular and bursal surfaces (involving greater than 90% of the tendon thickness) along with early glenohumeral joint osteoarthritis and mild subacromial subdeltoid bursitis.
But that's a different post, and probably the good news.

The C-spine MRI sounds much scarier and I'd really like to know what I'm dealing considering my profession which I love, my desire to continue doing it, and my knowing a shot of cortisone isn't going to FIX anything. As much as I want this pain to go away, I don't want to be dealing with it again over and over if it really does need fixing to go away.

The findings say there is marked spondylotic change mainly of the lower cervical spine.
At the C2-C3 level, there is left uncovertebral joint hypertrophic change and facet arthropathy resulting in moderate left neural foraminal stenosis.

At the C3 – C4 level, there is a broad-based disc osteophyte complex effacing the anterior thecal sac resulting in an AP dimension of 8 –9 mm. There is bilateral uncovertebral joint hypertrophic change and mild facet arthropathy resulting in moderate to severe left and moderate right neural foraminal stenosis.

At the C4 – C5 level, there is broad-based disc osteophyte complex eccentric to the right. This effaces the thecal sac and flattens the cord resulting in an AP dimension of 6-7mm. Bilateral degenerative change greater on the right and mild facet arthropathy in combination with the disk osteophyte complex results in severe right neural foraminal stenosis with the neural foramina are obliterated in the right side of the cord is distorted as well moderate severe left foraminal stenosis.

At the C5 – C6 level, there is broad-based disc osteophyte complex and moderate facet arthropathy resulting in AP dimension of 7-8 mm and moderate to severe bilateral neural foraminal stenosis.

If the C6 – C7 level, there is a broad-based disc bulge in moderate bilateral uncovertebral joint and change of facet arthropathy resulting in moderate to severe left and moderate right neural foraminal stenosis. There is marked facet arthropathy in the upper thoracic spine resulting in moderate to severe bilateral neural foraminal stenosis from T1 – T2 through T3 – T4.

The cervical spine is in anatomic alignment. The bone marrow signal intensity is normal. The spinal cord is normal in signal intensity. There is no acute disc herniation. There is no Chiari malformation

 
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Old 05-30-2011, 02:51 AM   #2
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Re: Need help understanding C-spine MRI~NOT cortisone shot

I dont understand ALL of the terminology but I do see youre probably dealing with some nerve damage. Early signs are numbness and tingling and foraminal narrowing is notorious for compressing nerves. This is usually reversible -not always.

My understanding is that cortisone is not the only available shot. You are right though that they tend to be more of a delay than a fix. I've known people to undergo epidural injections and be 'like new' for another 6+ mths. Then I know people (myself included) whove experienced no relief at all. (My first injection lasted about 3.5 wks, the next done nothing.) Many of these shots target inflamation. When the inflammation decreases, so do your symptoms. I think also some people seem to feel better until they return to their old ways (habits, work, etc) where nerves are irritated all over again.

There are many who never get back to their-norm after surgery, and there are many who end up much worse. Of course there are many who do well and feel great. Post surgery risks are 'so high' (residual pain can be worse than the initial pain, believe that) and unpredictible that I would postpone surgery for as long as possible. They are always discovering new treatments and methodolgy whereas waiting isnt always a bad thing IF they can manage your pain and functioning effectively and without causing more damage waiting. If I were you, even considering your occupation, I would TRY injections before rushing into surgery. One of my neuro's said he had a patient last 3 yrs on one injection. My brother had a cervical injection and is still doing well (working hard, pipefitting) a whole year later.

Also, while your report sounds a bit scary, it 'could be' their technical way of saying your spine is 50 yrs old. I do notice c-spine IS in anotominal alignment (which is a plus), no herniation (another plus), no chiari malformation (plus), and a normal bone marrow signal intensity (plus). I would think if that was the report summary that if the cord was in compression jeopardy it would be noted.

Tendinosis is really painful and typically a red flag regarding blood flow. This is pretty serious (definetly avoid the antibiotic Cipro). Also, once you develop tendonitis or tendonosis, the problem often presents itself over and over. Be sure to stay on top of this one. You may find some relief in anti-inflammatory meds (like naproxen/OTC-Aleve 2 times a day or ibuprofen) and a proper icing regimen. Exercise may loosen you up enough to improve blood flow but be careful you dont stress the tendon further. Ask what specific movements you can do, they like to believe rest fixes tendonitis/tendonosis but if you cant loosen the muscle, believe me, you will face recurrent flares or eventually tear the tendon completely.

I certainly hope you feel better soon.

 
Old 05-31-2011, 07:29 PM   #3
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Re: Need help understanding C-spine MRI~NOT cortisone shot

I love that cat avatar too!

Your neck is not good. So let me do a little explaining by level.

C2-3-it talks about facet and uncovertebral joints having "hypertrophy" and "arthropathy"...both mean arthritis and the "joints" mentioned are very small joints on the outside of the vertebrae that connect with the same joints above and below and have to do with stabilizing the spine. In your case, they have developed arthritis and the bone spurs from the arthritis have caused the "foramina" to close up. The foramina are holes on either side of the vertebra that allow the spinal nerves that leave the cord, to go out to the body and when they are closed up by anything such as bone spurs, causes severe pain. They rate the amount of closing by the words...minimal, mild, moderate, severe and obliterated. You have moderate closing up on the left side which might cause headaches and scalp pain.

C3-4-you have that same situation with this level as regards the foramina being blocked but here, you are moderate to severe on the left side and moderate on the right side. This would affect the neck/shoulder area, including some the areas where you are experiencing pain. But you also are developing another problem and that is a herniated disk mixed with bone spurs affecting your spinal cord itself. You have a "complex" of them hitting the lining that covers your spinal cord(the thecal sac) and it has closed up your spinal canal(that holds the cord) to 8-9mms. Normal is 11-12mms. More on the symptoms of cord compression later on.

C4-5-let's start with the foramina again. Bad bone spurs once again are blocking the holes for the nerves. On the left side, it is moderate to severe but on the right side, it is severe with an area of the "hole" "obliterated". That means they can't even see whether it is open or not and the bone spurs even push the cord in a weird way. This is where your symptoms will tell the docs what is going on. Affects the upper arms and shoulder areas and some into the arms. And the cord is affected again by a mix of a herniated disk and bone spurs together pressing on the thecal sac and the cord itself so that your cord is down to 6-7mms.

C5-6-same story here...foraminal closing up in the moderate to severe range on both sides and a spinal cord that is being compressed down to 7-8mms. Along with what is at C4-5, your arms must be in bad pain or going numb. Bet you're losing strength too...and dropping things. C6 goes down to the thumb and index fingers and some of the middle finger.

C6-7-the foramina are again closed up. Moderate to severe on the left and moderate on the right. And they can see the same problem with moderate to severe closing up all the way down from T1 to T4. But no cord compression from here on down. C7 affects the 3rd and 4th fingers and outside of the arm and the C8 nerve(between C7 and T1) affects the little finger and the far outside edge of the arm and triceps muscles.

Your spinal cord is compressed at several levels and can cause strange symptoms like difficulty walking, staggering as you walk, having muscles that don't seem to want to work and you take baby steps. Numbness anywhere in the legs(even the toes). Your arms may not work right and you can lose strength even without the nerve problem. You may lose fine motor function in your hands. You can develop problems with your bladder not working right and you either can't go or you can't hold it. Same for bowel function. If you get bladder or bowel problems, that can be very serious and needs emergency attention. But it may not hurt...but the rest of the nerves hurt enough.

What is happening, is that you are slowly but surely becoming paralyzed and you need surgical intervention to stop the progress. My neck was very similar to yours and slowly but surely, I had less and less pain so I thought it was getting better when in fact, it was getting worse. No pain is a bad sign with this problem.

You need to find the best spine surgeon you can get. If I were you, I'd head to the biggest medical center near to you and find the top spine surgeon, be it ortho or neurosurgeon. You are going to need some pretty big surgery done to fix this....BUT IT IS FIXABLE. Mine was fixed.

And I also had the torn rotator cuff on one side and the partial on the other and the AC shoulder joints needed to be excised and basically my shoulders were a mess. So I had the shoulder surgeries...and then found out about my neck. My pain had been 90% neck all along. Should have had the neck first and then the shoulders. But it was another year after the 2 shoulders before I found out I even had a neck problem when I went numb from the neck down. Fix the neck first.

This is one time when experience counts as well as expertise. Travel where ever you have to, to get the very best spine surgeon you can get. May mean the difference between working again or never working again and being in constant pain.

Good luck.............Jenny(fused C3 to T1)

 
Old 06-01-2011, 11:35 AM   #4
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Re: Need help understanding C-spine MRI~NOT cortisone shot

Only have a minute now, will post more details later, but want to express a huge heartfelt thanks for the imput. Very much appreciate it and I'm getting the help I need. Till later. Thank you and have a wonderful day!

 
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facet arthropathy, foraminal stenosis, osteophyte complexes, thecal sac, torn supraspinatus



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