Join Date: May 2011
Location: So Cal
Re: Cervical Spondylosis - need help understandind an MRI
OK, I'm going to assume that he got a little sloppy, and that "minimal" refers to the left foraminal narrowing. That makes the most sense.
I think you really need to get a clear and complete understanding of your situation. You need to talk to at least THREE docs, and you should be educated enough beforehand so that you can have a real conversation with them, and not just get brushed off with a "you need this, see my secretary to schedule surgery". So what I'll do is just provide some info to get you started.
Your spinal CORD runs down the middle of a cage-like structure attached to, and in the rear of, your vertebrae. The CORD is contained within the CANAL. Between the cord and the membrane on the outside of the canal is fluid. Your radiologist is referring to the space between your cord and this membrane as the "subarachnoid space", which is correct, but is a term usually reserved only for the brain and not the spinal cord. Over time, several things can intrude into this space: disks being squeezed from in front, ligaments being swollen from behind, and bone spurs (osteophytes) growing off the vertebrae, or off any part of that bony cage surrounding the canal. The subarachnoid space gives you some leeway before these intrusions actually affect the spinal cord itself.
Some people (me, for one) have a condition called "congenital canal stenosis", whereby we are born with a canal that's too narrow. For example, the spinal canal should be about 18-20mm across, with the cord filling perhaps 10mm inside the canal. If you have congenital stenosis, the canal might be 11-12mm, so you can see that there's very little subarachnoid space left to protect the cord. The fact that you have so many things "effacing" (pushing away) that subarachnoid space, leads me to suspect that you may have some degree of congenital stenosis, as well. It's very important to find this out, because the knowledge will have considerable bearing on a choice of surgeries.
At each level, you have a nerve exiting the spinal cord on each side. These nerves - in the cervical spine - head off into your neck, shoulders, and arms. When they leave the cord, they pass through an opening in the bony cage called the "foramen". When something intrudes on the foramen (either a disk being squeezed from in front, or osteophytes growing off the surrounding bone) the nerve root can be affected, potentially causing the entire range of symptoms from false sensations (tingling, etc) to loss of sensation, to loss of motor control. This is called "radiculopathy", which just means "problem with the root".
When a foraminal opening is affected, the symptoms will occur in the area covered by the associated nerve, e.g. the left C5-6 will affect your left deltoid, biceps, and fingers (maybe just little finger? I don't remember).
However, if the CORD is negatively impacted, then the symptoms can occur ANYWHERE BELOW the problem.
If you have only arm symptoms (and if they only occur relative to neck movement), and you have NO leg symptoms, there's a good chance your immediate concern is one or more foraminal opening. If you have any leg symptoms, then your cord is involved.
Surgically, there are three basic approaches. They are not equal or mutually substitutable. One will be best, which one depending on your real condition.
1. The ACDF is when the surgeon comes in from in front, removes a disk (or more than one disk, if it's a multilevel surgery), puts a shaped piece of donor bone in place of the disk, then secures it all with a titanium plate. This has the benefit of immediately addressing problems caused by disks and POSSIBLY, to some extent, also addressing SOME of the osteophytes (you would want to find this out).
2. The LAMINOPLASTY is where the surgeon comes from BEHIND, cuts through the "lamina" (a part of the aforementioned bony cage) on one side and swings the lamina out. He then puts a piece of donor bone into the gap, and secures it all with a titanium clamp. This would be done for at least three levels. The whole purpose is to address the canal stenosis, to give the patient the room within the canal that he should have had by birth. At the same time, the surgeon can trim away the osteophytes impinging on the foraminal openings. This surgery does NOT directly address bulging disks, but it does give the spinal cord space to move away from the disks.
3. The FORAMINOTOMY is when the surgeon comes in diagonally from behind and on one side. All he does is grind away the osteophytes growing into the foraminal opening. The surgery is much less invasive than the other two, and should actually be outpatient.
For the record, I have had all three surgeries... a C3-4 ACDF in 1996, a C5-6 foraminotomy in 2004, and a C4-6 laminoplasty four months ago. Sorry to tell you this, but you might want to accustom yourself to the idea that you will also need multiple surgeries.
From your description, I think you MAY get away with just foraminotomies for now. A laminoplasty, with accompanying foraminotomies, might be the best overall solution. This would depend on whether or not congenital stenosis is your root problem. The trouble with laminoplasties is that many surgeons can't do them, or can't do them well. Also, they don't directly address the bulging disks. The radiologist didn't say how far out the disks were bulging (he should have given measurements in mm), so we don't know just from the report how much of a bulge you'd have left after a laminoplasty.
Another solution might be to do an ACDF at (probably) two levels, and then follow that up a few weeks later with foraminotomies to address the osteophytes. This combination will deal with the disks and the osteophytes, but won't help you with your congenital stenosis, if you actually have that.
So.... I hope this helps a little, and gives you at least a start on educating yourself in preparation to go back and talk to the docs. If there's anything else I can do, just ask.
Keep in mind, of course, that I'm just an "experienced" amateur...
Last edited by WebDozer; 10-12-2011 at 10:12 AM.