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Old 10-27-2011, 04:44 PM   #1
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Smile Help to interpret Cervical MRI report

A family member has been having neck pain and just had an MRI. Here are the results. Can anyone help interpret this report? We are also wondering what the possible treatments would be if any? Thanks!

IMPRESSION:

1. STRAIGHTENING OF THE NORMAL CERVICAL LORDOSIS, WHICH MAY BE RELATED TO POSITIONING, MUSCLE SPASM, OR SPONDYLOSIS.

2. MILD CENTRAL CANAL STENOSIS FROM C3-C4 THROUGH C6-C7.

3. SEVERE NEURAL FORAMINAL STENOSIS AT C3-C4, MODERATE NEURAL FORAMINAL STENOSIS AT C5-C6 AND C6-C7, AND MODERATE RIGHT/MILD LEFT NEURAL FORAMINAL STENOSIS AT C4-C5.

 
Old 10-27-2011, 05:28 PM   #2
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Re: Help to interpret Cervical MRI report

Hi Freedog....I'm one of the MRI interpreting people so I'll see if I can help you.

1...straightening of lordosis due to positioning, muscle spasm or spondylosis. Our neck has a curve in it. If you look at the spine from the side, the neck curves inward toward the front of the neck then outward at the shoulder blades then inward again at the waist and then a small outward curve again at the very bottom. This is known as lordosis in the neck. It normally starts to go straight with age but can also look straight due to the position on the MRI machine or go straight due to muscle spasms pulling on the neck(and therefore may be fine when spasms stop) or go straight due to arthritis(spondylosis is the name for arthritis of the spine).

2....mild canal stenosis from C3-4 to C6-7. The spinal cord goes down through the vertebrae through an opening called the spinal canal in the back portion of the vertebrae. Diameter of the canal can differ so I won't give parameters but in general, radiologists list the amount of closing up of the canal by the words, minimal(1), mild(2), moderate(3) and severe(4). If you think of it as a number scale then a 2 out of 4 is not too bad but a 4 out of 4 is bad. So this relative has a problem but it is not significant as yet. Stenosis is the medical word for "closing up" whether it be the stenosis of the spinal canal or stenosis of an artery or valve in the heart. In the spinal canal, the closing up can come from being born with a narrow canal or from herniated disks filling it up or arthritic bone spurs building up or even a process where the canal itself begins to thicken.

3...this is where there is a problem. The "foramen" is the opening in the vertebral bone that allows the nerves to go out to the body. At each vertebra(except the first one) a pair of nerves peels off the cord and exits the bone by this foramen(foramen is medical for "opening") and in this case, there is foraminal stenosis...opening closing up. Again, they rate the degree of closing up with minimal(1), mild(2),moderate(3) and severe(4) and sometimes obliterated(5). So at C3-4, in the high neck, there is severe stenosis ...a 4 out of 4/5...bad. Moderate stenosis is listed for C5-6 and 6-7 a 3 out of 4/5 on the severity scale. The least amount of stenosis is at C4-5 where the right is moderate(3 out of 4/5) and mild on the left side(2 out of 4/5). Many things can cause the foramen to close up such as disk material and bone spurs.

All of this stenosis causes a lot of pain. It means a nerve is being compressed and that hurts like a son of a gun. But most spine docs will not operate until you reach that severe range(4 out of 4/5). At that point, they worry about the blood supply to the nerve being stopped by the compression and the death of the nerve. Nerve death means paralysis of the muscles fed by that nerve. So at that point, the pain may change to numbness, pins and needles sensation and muscle weakness....early signs of paralysis.

So I hope this explanation helps you pass along the info to your relative. I find using the number scale helps to get it across a little easier...you have a 4 out of 4 blockage says it pretty well.

Any questions, I am around.

Jenny

 
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Old 10-27-2011, 06:51 PM   #3
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Re: Help to interpret Cervical MRI report

Wow. Thank you for such a thorough reply. Very helpful to help us decipher this report. Are you a radiologist, or just had lots of experience?

 
Old 10-27-2011, 06:52 PM   #4
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Re: Help to interpret Cervical MRI report

If anyone has had a similar diagnosis, I would be interested in hearing if you've had any successful treatments. Thanks.

 
Old 10-28-2011, 07:00 AM   #5
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Re: Help to interpret Cervical MRI report

You have not indicated what the cause of the foraminal stenosis is. It could be bone spurs growing from the bones surrounding the foraminal openings. It could be disks being pushed backward into those openings. It could be both.

If it's bone spurs, there is a minimally-invasive, probably-outpatient surgery called a foraminotomy, where the surgeon comes in from behind and grinds off those bone spurs.

If the problem is disks, then the most common surgery is the ACDF, which involves removing the disks by coming in from in front.

So... there's not a whole lot more people here can say w/o a more detailed radiology report. It's hard to believe the radiologist wrote something so inadequate, so maybe you'll be able to get something better?

 
Old 10-28-2011, 07:08 AM   #6
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Re: Help to interpret Cervical MRI report

All I typed here was the Impression, but not the rest of the report. It does mention some bone spurs also, so you're right about what you said. Thanks for your input. It is much appreciated.

 
Old 10-28-2011, 07:11 AM   #7
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Re: Help to interpret Cervical MRI report

Hopefully, a foraminotomy is all that's needed. If you feel like typing the body of the report (at least for the worst levels), we can give better feedback....

 
Old 10-28-2011, 03:43 PM   #8
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Re: Help to interpret Cervical MRI report

Hi Freedog....I write from my own experience of having to decipher my own reports. I've had 2 big neck surgeries and and may be looking at a 3rd.

And then there 's the lower back......

Glad I could help you but if you want to add the entire report, we can give you a better idea of options out there.

Jenny

 
Old 10-28-2011, 08:27 PM   #9
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Smile Re: Help to interpret Cervical MRI report

Ok, here's the entire MRI report, if anyone would like to interpret
and comment.... We haven't had a doctor's opinion on this yet.... just
recently got the report. Thanks

---------------------------------------------------------------------------

CERVICAL SPINE MRI W/O CONTRAST

HISTORY: Chronic Neck Pain

TECHNIQUE: Sequences performed: sagittal T1,T2, and STIR and axial T1 and gradient echo without IV contrast.

COMPARISON: NONE AVAILABLE

RESULT: Counting reference: Craniocervical junction.

There is straightening of the cervical lordosis. Vertebral height is maintained. Multilevel disk degeneration most pronounced around C3-C4 through C6-C7. The visualized posterior cranial fossae and paraspinal soft tissues are unremarkable. Spinal cord signal satisfactory. Soft tissue thickening posterior to the odontoid process may reflect remote trauma or ligamentous laxity with secondary degenerative change.

Axial Images:

C2-C3: No disc herniation or stenosis. There is mild facet degeneration.

C3-C4: Broad-based disk osteophyte complex and uncovertebral/facet degeneration results in mild central canal stenosis and severe neural foraminal stenosis.

C4-C5: Broad-based disk osteophyte complex and uncovertebral hypertrophy results in moderate right/mild left neural foraminal stenosis and mild central canal stenosis.

C5-C6: Broad-based disk osteophyte complex and uncovertebral/facet hypertrophy results in mild central canal stenosis and moderate neural foraminal stenosis.

C6-C7: Broad-based disk osteophyte complex and uncovertebral hypertrophy results in moderate neural foraminal stenosis and mild central canal stenosis.

C7-T1: No disk herniation or stenosis.

IMPRESSION:

1. Straightening of the normal cervical lordosis, which may be related to positioning, muscle spasm, or spondylosis.

2. Mild central canal stenosis from C3-C4 through C6-C7.

3. Severe neural foraminal stenosis at C3-C4, moderate neural foraminal stenosis at C5-C6 and C6-C7, and moderate right/mild left neural foraminal stenosis at C4-C5.

Thanks

 
Old 10-29-2011, 06:00 AM   #10
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Re: Help to interpret Cervical MRI report

Freedog, thanks for taking the time to post the rest. Interesting that there's disk osteophyte complex at four levels. My uneducated guess is that the straightened lordosis may be the indirect cause, that is, the spine is generating extra bone in an attempt to reinforce itself against the pressure of the head pulling forward and down. Perhaps the uncovertable hypertrophy is, as well.

All we know of symptoms is "chronic neck pain". Are there any shoulder/arm/hand problems, that might be caused by the foraminal stenosis? Is the neck pain concentrated on one side?

I would think that, at least, exercise and PERHAPS some forms of manipulation may be in order to treat the straightened lordosis before it causes even worse problems.

As for surgery, it would seem that an ACDF (at C3-4) might be too much. I still think that a foraminotomy could be the solution, but I'm not fully educated as to the range of problems that can be corrected by foraminotomies. My guess is that they could deal with the uncovertable hypertrophy, but could they also address the disk osteophyte complexes? The latter are growing from in FRONT of the spinal canal, while a foraminotomy comes in from the BACK (diagonally), so can the foraminotomy get at them? I've seen commercial sites that claim their surgeons can do that. I had a foraminotomy a few years ago, but I do not believe it was addressing disk osteophytes.

Anyway, I suggest you learn as much as you can about foraminotomies before you talk to a surgeon. You never know if you're going to get someone who's so indifferent that he either dismisses your relative w/o surgery, or just blithely suggests ACDF's because that's what he wants to do (or worse, all he KNOWS to do). If he doesn't do foraminotomies, you MUST find someone who does. I want to stress that I'm not saying that a foraminotomy is necessary in this case, but you want to be told that by someone with considerable experience doing them.

PLEASE post what the surgeon has to say. This is not idle curiosity. I, and others, will want to know more about treating disk osteophyte complex and uncovertable hypertrophy in a context of straightened lordosis so that we'll be in a position to answer others' questions about them.

Last edited by WebDozer; 10-29-2011 at 06:08 AM.

 
Old 10-29-2011, 06:17 AM   #11
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Re: Help to interpret Cervical MRI report

This helps, Freedog.

The first part of the report mentions that there seems to be tissue thickening near the odontoid process which is at the base of the brain near C1, that looks like a there may have been ligament damage...someone have whiplash? Explains why so much high neck damage.

To add to the previous info I gave you, the disks in may areas are actually disk/osteophyte complexes. Osteophytes are bone spurs from arthritis and they can form around a herniated or bulging disk. This makes the bulge much harder and more likely to do damage.

The other thing being reported is hypertrophy of the uncovertebral and facet joints. These are small "protrusions" on the exterior of the vertebra that form joints with others above and below and work to stabilize movements such as twisting. They are very close to where the nerves exit from the bone and can block them as well as the disk matter. And they produce a lot of neck pain.

Where the foramina are listed as having severe blockage, they can do a surgery called a foraminotomy where they just open the hole for the nerves. But that does not address the canal stenosis. They don't give the dimensions of the canal or cord but I was moderate at 5-6mms so at mild, the cord would probably be compressed to about 8mms. Webdozer and I have both had a surgery called a laminoplasty(very new and not too many docs do it) where they go in from the back and remove the bone over the canal and reshape it and replace it, doubling the size of the canal and removing pressure from the cord. At the same time, those forminotomies can be done rather than a separate surgery(I think Web had his done first and the laminoplasty second). But it has the drawback of not removing the disks. In order to do that, they have to go in from the front and pull out the disk material(if they can get it all) and then they have to fuse the vertebrae together because the support in between them is gone so that means plates and screws to fuse them together. (Actually, I'm not sure about that...Web do you know...if you are already fused from the back, do they still have to do plates and screws in the front of the take out the disk???)

The problems with necks begins with fusions. Once you fuse a block of vertebrae together, it rocks on everything below it and slowly destroys it, making more surgery necessary. If done well, it's a good surgery but if not, it can have a ton of complications. Need to top doc...period!

My neck was pretty close to this one and I had the laminoplasty with forminotomies at the same time. No fusion is done at that time. Ideally, I would eventually need the disks removed from the front and the vertebrae fused but that would only be done IF the disks continued to move back. I do have 1 of the 5 herniated disks that has continued to move and it will probably need that surgery. So had things gone as planned, I would have had most of the problems fixed without fusion from the back and then eventually, just 2 vertebrae fused when they removed that migrating disk. I would have kept most of the movement of my neck and that was the goal. That was my doc's plan...but not my body's.

However, had I had the more conventional approach, it probably would have meant going on from the front and removing all the disks and fusion of my entire neck from the front and the going in from the back(as that does not address the canal problems) and doing laminectomies where they remove the bone over the cord and leave it exposed to injury for life, with additional rods to hold the neck in place.

That is why I opted for the new surgeries to give me the best chance of a neck that moved and a cord that remained protected.

As happens, I had a major complication(an unheard of one at that)where I tore a damaged ligament and that triggered multiple dislocations and fractures. I had to have all 6 vertebrae fused from the back but my cord remains covered and protected. And I'm waiting to find out if I have to have that one bad disk removed from the front. In hindsight, I still think I made out better than with the traditional approach as my cord is protected from damage.

Webdozer...want to weigh in on what you did? What options do you see?

Jenny

 
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