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Old 10-11-2011, 09:55 AM   #1
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Cervical Spondylosis - need help understandind an MRI

1st-time post for me, thanks in advance to any that might reply with helpful information. I'm a 52 yr.old male that , for the past few months have had a continual left arm and left hand pins and needles sensation (like when sitting cross-legged and your legs go 'asleep" -- its the sensation like when a limb is doing the "waking-up" part. The tip of my left pointer finger, from the knuckle closest to the nail, has been totally numb for a month, or so. Whenever the pins and needles, mixed with numbness, etc., are presented, I turn my head as far to the right as I possibly can....and as I do so....I physically "feel" a degree of "normalcy" return to the left arm and hand. If I look up for a few seconds...or down....or to the left....the sensation kicks in, almost immediately. Not to mention the "pressure and heaviness sensation on the back of my neck...complete with an irritating, mostly chronically-felt headache in the area where the C-spine is connected to the base of my skull.


Here, in its entirety, is the MRI report. I am finding that I need to google almost each and every word, in my attempt to understand it.
any help would be appreciated.

FINDINGS:

"There is a normal cervical lordosis. A slight retrolisthesis of C3 and 4 is present. Vertebral body height and marrow signal is within normal limits. There is diffuse disc signal loss with disc height loss greatest at C5-6. The cervical medullary junction is normal. There is no evident cord signal abnormality. T2-3 and T3-4 posterior disk osteophyte complexes are present without evidence cord compression.

CERVICAL DISC LEVELS:

C2-C3: No cord compression or foraminal narrowing.
C3-C4 Moderate posterior disc osteophyte complex and facet hypertyrophic changes present. There is near complete effacement of the ventral and dorsal subarachnoid space with mild ventral cord flattening. There is moderate bilateral foraminal narrowing.
C4-C5 Posterior disc osteophyte complex asymmetric to right confluent with a large right uncovertebral osteophyte there is facet hypertrophic change present. Mild asymmetric right ventral cord flattening with near complete loss of ventral and dorsal subarachnoid space is present. Moderate to severe right foraminal narrowing is minimal and left foraminal narrowing is present.
C5-C6 Moderate posterior disc osteophyte complex with loss of ventral and dorsal subarachnoid space There is mild ventral cord flattening. Mild facet hypertrophy is present. Mild left and mild right forminal narrowing is noted.
C6-C7 Mild posterior disc osteophyte complex which impresses the ventral thecal sac. No evident cord compression. Facet hypertrophic changes and small unconvertebral osteophytes combine to produce minimal right and mild/moderate left foraminal narrowing.
C7-T1 Small posterior disc osteophyte complex. No cord compression or foraminal narrowing.

CONCLUSION: Moderate multilevel cervical spondylosis as detailed above.

 
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Old 10-11-2011, 10:43 PM   #2
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Re: Cervical Spondylosis - need help understandind an MRI

Hi trmort,

To me, it sounds like arthritis changes in your neck, with bone spurs narrowing things enough to cause the nerve to be pinched.

Don't go by me though, hope your doc can go over your MRI step by step.

I had a nurse call my results saying "looks like just some arthritis." Then was referred to a pain doc for epidural steroid injections. He said " my injections probably won't help - it can't change the abnormalities I see." Then, finally referred to a neurosurgeon.

I ended up with a very successful surgery, but have to say that a friend of mine did avoid surgery with epidural steriod injections (ESI). Even though she still has narrowing, the steroids reduced the inflammation enough to where the nerve had enough room (no longer pinched) & it was enough help to make the symptoms go away.

Good luck with your situation. Take your time and do your homework. Don't rush in to anything. Hope you feel better soon.

 
Old 10-12-2011, 03:47 AM   #3
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Re: Cervical Spondylosis - need help understandind an MRI

""Moderate to severe right foraminal narrowing is minimal and left foraminal narrowing is present.""

I'd like to give you my impressions, but could your first fix this sentence? The "is minimal" makes no sense. I hope that isn't the way the radiologist put it. thanks....

 
Old 10-12-2011, 08:02 AM   #4
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Re: Cervical Spondylosis - need help understandind an MRI

Quote:
Originally Posted by WebDozer View Post
""Moderate to severe right foraminal narrowing is minimal and left foraminal narrowing is present.""

I'd like to give you my impressions, but could your first fix this sentence? The "is minimal" makes no sense. I hope that isn't the way the radiologist put it. thanks....
yes, axctually, its a "direct quote" from the radiologist. He actually used it twice: 1st on ther line, as you have quoted (re: his findings for C4-C5) - then again, he used the same wording for the coments re: C6-C7.


I've read AND RE-READ it and yes, thats exactly his choice of wording.

Still, I appreciate you taking an interestt - thanx for responding,

Todd Mortensen

 
Old 10-12-2011, 09:03 AM   #5
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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 09:12 AM.

 
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