Do you have your actual MRI report? Many of us here are pretty good at interpreting those reports and for us, gives us a better idea of where and how bad things are.
an example is the cord flattening. The cord can take a lot. My cord was compressed to less than half thickness. One doc said operate now and another said I could wait longer based on what symptoms I had. It's not so much what they see on the MRI but what the symptoms are in your body. If you have a lot of numbness and trouble walking and signs of muscle function diminishing, then you need surgery. If you have few symptoms, then you can wait. But just saying you have cord flattening says nothing...how wide is the cord at the compression point...that might be on your MRI report.
So if you have that, can you post it as it's written?
PS...whatever you have done, make sure you have the very best spine doc you can get. Your outcome will be based on your doc's expertise and not your condition.
I second what Jenny said about the complete radiologist's report. Your condition sounds somewhat like mine, and maybe somewhat like (one of) Jenny's.
A flattened cord might be very serious. Myelomalacia IS very serious. Foraminal narrowing can cause a LOT of symptoms, but is relatively easy to fix.
From what you wrote, it's very hard to tell even what direction a surgeon should be coming from. Most surgeons will want to come in from in front (ACDF), but it's quite possible that the best option for you is a more global solution, coming from behind (laminoplasty). Jenny and I have both had'em all...
We can't tell you what to do, but we can explain alternatives and get you started on educating yourself, so you can talk to (at least) three surgeons and discuss options with them, rather than just being abruptly told what you need by the first surgeon and going along with him because you don't know enough to hold your own.
Could you also include a description of your various symptoms?
It actually began at age 24 to my knowledge. I had been in an abusive relationship from age 18 til abt 24...(I have no idea what the cause is nor when it began at the neck, just when I began hurting in upper back)
At age 24 I went to a Chiropractor because my upper back was always hurting , head aches and my right shoulder was popping with every movement......The Chiropractor said I had the back of a 40 plus woman....I had always heard they were quacks so I didnt listen, and lived as normal...
(I am 37 now)..In 2008, I complained to my general Dr in a different city and they did a nerve conduction test.. That showed Bad results in right and left shoulder and I had corpral tunnel in right hand.....The test showed left shoulder was worse than right.....This dr only said I may need surgery later in years....
About 6 months ago, I began feeling alittle off balance, nervous like crazy, increased pain and blurrness in my eyes, lower and upper back pains, feeling like I cant get enough breath at times, CONTINUOUS HEADACHES, loss of sleep because of pain and numbness with cold or stinging sensation in both arms..(one or both arms at a time)..Its easier to sleep on left side with knees in different positions and like this- I began extreme numbness and cold etc in right arm and mainly hands.....Dr has said I do have arthritus now along with corpral in right hand...In past month, increased mid back aches as well.....
I went in for MRI for both shoulders and this new Dr said she wanted MRI on neck too because she believes I had 5 seperate issues.....(left and right shoulder issues, neck issues, corpral tunnel and arthritus)..She was focusing just on shoulders and back and on 11-7-11, MRI came back on neck proving her correct...I just found all this out that Monday...All this time I thought it was my shoulders/back....I been running a Lumber Yard, driving forklifts, dispensing propane, and loading trucks etc...
I included one of the MRI of neck to my original post.....
I am grateful for anything of experience ....My husband is so worried and freaking out that he wants me to be at FONDRON CLINIC in Houston Tx...And he too is demanding more specialist .....I am just trying to absorb it all...
And by the way, This Dr said she doesnt believe my arthritus is Rumatory or however you spell it.. lol
And both shoulder do have issues as well..No tears or broken areas, Just type 1 acrminon, Supraspinatus tendinopathy, bursitus etc etc ... But the main concern is obviously the neck.
Shareie... You certainly have and have had way more than your share of troubles, especially for someone so young. I'm really sorry about that. You finally found a good doc, though, that is, the one who sent you for a cervical MRI. Many docs would have gotten lost in all your other problems/symptoms and not picked up on the signs of cord damage.
Unfortunately, you were stuck with a lousy, lazy radiologist for reading the cervical MRI. (Maybe I am being too harsh and, if so, Jenny will let us know.) That report may be the worst cervical MRI report I've ever seen. How on Earth can this guy talk about a FLATTENED cord (with possible MYELOMALACIA, no less), without attributing the cause is beyond me.
Anyway, we have to work with what we have. To start with the flattened cord, it is helpful to think about what a normal anatomy would look like. For a woman, and at that level, you might expect a healthy canal to be roughly 17mm AP (front-to-back) diameter. The outside of the canal is the thecal sac. Inside the sac is spinal fluid. "Floating" within that spinal fluid is the spinal cord. The fluid serves both to nourish the cord and to provide a buffer. So let's take a top-down view of a healthy spine, and say there's 17mm from the front outside of the thecal sac to the back outside. In both front and back there might be 3.5mm of fluid, and then a 10mm-wide cord within that.
With age (and with injury), a number of things can intrude on the canal and press inwards. Herniated disks from in front, disk bone overgrowth (osteophytes and osteochontral bars), also from in front, bone spurs from the sides, and swollen ligaments from behind. To make matters worse, many people (myself for one) have a condition called "congenital canal stenosis", which just means that our heredity has bestowed us with too-narrow spinal canals, giving us less "leeway" before the various problems listed above impact our spinal cords. Given your 8mm canal diameter, I'm guessing that you also have congenital canal stenosis to some extent. The radiologist should have mentioned it, but he wasn't being very thorough.
If you have an 8mm canal, then one or more things is pressing on it. Still, that's not terribly narrow. What usually happens is that the pressure "effaces" the spinal fluid, so that the cord loses its buffer with the canal and presses right up against the thecal sac. In and of itself, that may or may not be serious. I suppose it's possible that you may have a 7mm cord squeezed inside that 8mm canal, but I'd have to guess 6mm is more likely. I have twice had my cord compressed down to 5mm (although both times surgery was called for). In your case, though, the possibility of myelomalacia would make one lean toward the flattening of your cord being serious enough to require immediate remedy.
In spite of the vagueness of the report, two problems stand out: the osteochondral "bar", which is certainly a factor in flattening your canal, and the hypertrophied uncinate process, which is impinging on your peripheral nerves (going to shoulders and arms, at this level). I'd go out on a limb and take an uneducated guess that it's really all one problem. Some kind of stress on your neck has prompted your vertebrae to try to stabilize themselves by growing extra bone (Jenny would know more about this than I). In the back of the vertebrae, this takes the form of the osteochondral bar, which is pressing on your canal/cord. On the sides of the vertebrae, it's taking the form of extra bone growth on the uncinate processes, and this is starting to choke off the foraminal openings through which your nerve roots pass as they leave the spinal cord and head down into your arms.
As for what to do about this, I really don't know. I doubt that it's so obscure a problem that it has not been addressed many times before. My guess is that most surgeons would want to do an ACDF (anterior cervical diskectomy/fusion), where they come in from in front, remove a flattened disk, and substitute a piece of donor bone, then clamp the whole thing together with a titanium brace. What I don't know is if an ACDF will be able to address the bone overgrowths, because those are in BACK of the vertebrae, and the ACDF comes in from in front. Of course, that's a question the surgeon can easily answer.
Another possibility is a "laminoplasty", where the surgeon comes in from behind, cuts through the "lamina" on the back/side of the spinal canal, swings the lamina open and then props it open with donor bone and a titanium brace. The whole point of this operation is to take a congenitally stenotic (narrow) canal and open it up. This would allow the spinal cord to move backward, away from the bone overgrowths on the vertebrae.
A third operation, which would affect only your foraminal narrowing, is called "foraminotomy". It's minimally invasive microsurgery that comes in diagonally from behind and grinds away the bone overgrowth in your foraminal openings. In your case, this could be a separate surgery to complement whichever surgery addresses the cord flattening.
FWIW, I have had all three surgeries: ACDF, foraminotomy and laminoplasty.
Let me just end by saying that you need MULTIPLE opinions. I'd try to get at least three. I know that even with good insurance this is likely to cost more, but I think it's important. You also need to read up as much as you can on spinal structure, and on all three of the operations I mentioned, because I think it's critically important that you are able to have informed conversations with the surgeons you see. Might not be a bad idea to take your husband into these conversations, too. Strength in numbers...
Thanks alot for all the info..... I go back to general Dr today at 3 with my husband ---He is the one demanding many opionons and different specialist etc...I believe we dont understand Myelomalacia and how serious it is...Or anything...
But I deeply appreciate all the info ...Thanks again_
Quick question-- i do have the mri disk that covers all pic of neck, both shoulders and includes xrays of back/shoulder...the disk also includes complete final exam results writen on the disk of all 3 mri exams.....should i take it to a specialist and have them relook at it and diagnose their findings? Or what do you suggest me to do in order to get a better radiologist report..
Of the three neurosurgeons I've seen, two wouldn't even look at the radiologist's report. They were openly contemptuous. I don't think that's surprising, as the radiologists have to deal with a very wide range of problems, while spine surgeons are much more specialized.
I think that, if you get a decent neurosurgeon, he will not use the radiologist's report as more than a starting point (as it would leave him with all the questions I mentioned). He'll go straight to the images.
But, to answer your question, of COURSE you should take the disk. Just be sure they give it back to you when they are done, so you can take it to the next doc. Let them make a copy, if they want.
I don't think you will get a better radiologist's report, but I do think that the surgeons will expand on it for you. They will likely make a recording of their impressions which will later be transcribed, and you should be able to get a copy of that.
Last edited by WebDozer; 11-10-2011 at 09:23 AM.
The Following User Says Thank You to WebDozer For This Useful Post: SHAREIE (11-10-2011)
Hi Shareie.......I see my friend Web has already given you a pretty good idea of what is going on in your neck. And he's right...crummy report by the radiologist.
Let me just sum it up....your neck consists of 7 bones(vertebrae) C1 down to C7 but C1 and 2 are kind of off by their own. C3 thru 7 make up most of our neck. You have disks that are thinning and not doing their job starting at C4-5(disks are in between the bones so are give as which bones they are between)and then worse at C5-6 and C6-7. Your major problems are at C5-6 and C6-7 and they are different problems.
The pain and numbness you are getting in your arms is probably from the problems at C6-7 where you have bone spurs pressing on the nerves to your arms. Most arthritis in the spine is osteoarthritis, not rheumatoid(that is rare in the spine and creates totally different problems). The bone tries to fix itself by building more bone....but usually does it in the wrong place and causes more problems than it fixes. As Web said, they open up the place that is blocked by these bone spurs and relieve the pain.
But the bigger issue, is the problem with your spinal cord. It is not unusual for a bad disk to rupture backwards toward the spinal canal/cord. If you look at the pics of your spine, the disk is right up against the canal so it doesn't take much(think jelly donut in between 2 bones). In your case, the disk has done exactly that and bulges backward into your spinal canal...think of a jelly donut that has shot it's jelly right into the spinal canal up against the spinal cord. But in your case, the jelly was shot out of that donut a quite a while ago and has hardened to rock hard....so hard it has formed bone.
If it was still somewhat soft, it might not hurt your spinal cord but it has hardened and that hard stuff pushing on your spinal cord has injured the cord and is making it go soft. Ever had a cucumber get a spot of mold on it? And what happens to the nice firm cuke...the area under the spot of mold gets soft and mushy. That is what this area of "bone like disk stuff" is doing to your cord. It has to be removed and the faster the better. A soft mushy cord can recover and get firm again but at some point, it will no longer heal and the problems become permanent.
Both problems can be fixed in the same surgery. They might go in from the front of the neck and pull out that bad disk and open the holes for the nerves below and then they'd fuse the bones together to keep it stable. Or they might offer you a newer surgery that goes in from the back and makes the new and better spinal canal(laminoplasty) that lets the cord move away from the disk. They can open the the area for the nerves then too. They don't fuse the bones together with this surgery so you have more movement in your neck but they also don't remove the disk and the problem could happen again. Something tells me they will suggest the first surgery as that disk really needs to come out for good. That is an "ACDF".
You have lots of options but for sure, that disk needs to get off your spinal cord and those nerves need to be freed up from the pressure.
I did a little research on the Frondren clinic and Texas Orthopedic Hospital and it looks very, very good. Hubby is right...go there ASAP. Spine surgery is one thing where the expertise of your doc will determine how you live the rest of your life...in pain or not in pain. You need a doc who does nothing but spine surgery and has all the latest equipment and surgeries to help you the best way they can.
Have the doc who ordered the MRI send a letter, or call the clinic and set up an appointment for you. I am 100% convinced you need some kind of surgery to get that pressure off your spinal cord. If the myelomalacia isn't stopped, you are looking at paralysis from your waist down and your hands. You'll be able to move your arms but be wheelchair bound.
That is the bottom line with spinal cords. You do enough damage and the blood supply stops and you are instantly paralyzed. That is why they operate...to prevent paralysis. You are already well on your way.
As for what you should do until then....I'd go out and buy one of those soft collars. You can get them in most drug stores. Put it on and keep it on during the day so you don't move your neck suddenly and it reminds you to watch out. Do not look up...that is when that boney area puts the most pressure on your cord. Just be very, very careful until you see a spine surgeon.
Your cord is not that badly compressed.....you are down to 8 mms and I was down to 5-6mms and one person here was down to 4mms. But in your case, it's the hardness of the bone hitting it that is doing the damage so it doesn't have to be really compressed. It's the hardness of it that is doing the damage. Mine was still somewhat soft so it didn't do that kind of damage.
Many people here have fusions in their necks. No one wants it but sometimes you face a much bigger problem is you don't. And they would only be doing C5-6 and C6-7 so you won't loose much motion. I am fused from C3 to T1 and can do everything I need to so if I can move, so can you. It's not that bad and it beats the heck out of being paralyzed!
Hang in there and keep us up to date. Any questions and we are here for you.
i included some pics......I am so blessed to have you both reply...I know all will be ok_ but I cant afford a mistake and experience is always a thing to concider and keep in mind.. I see you reply and help alot of others...I hope you all know that we newbees appreciate you and atleast I myself and my husband view you as blessings..Thanks so much...
Shareie, you have already received great advice from two of the best on this board, I just want to encourage you. When I was diagnosed with spinal cord compression from my vertebra being dislodged by a fall, I can remember being completely at a loss to grasp what was being said to me. My surgeon told me my cord was bruised. I went for a second opinion, and my husband went with me, and that made a huge difference. I had been told by both doctors that I needed both an ACDF and a rear procedure which would entail a 5 hour surgery, but my great neurosurgeon was able to put me back together all from the ACDF, and I didn't have the other incision to deal with. Also the surgery was only 3 hours. The progression of damage was stopped, and I have regained much, but not all of my muscle function, but I lead a fairly normal life. Don't go by yourself to any consultations. It helps so much to have someone else to listen also, and take notes. Ask pertinent questions. You will get through this.
ACDF C7-T1 bone graft and titanium plate 2008
The Following User Says Thank You to minstrel2 For This Useful Post: SHAREIE (11-11-2011)
Even though I already had surgery based on my symptoms and mri report, I was wondering if you could help me understand the mri report and what it means in plain terms...At c5-c6 there is a 4mm posterior extrusion of disc material which extends 4mm inferiorly behind the c6 verterbral body. It causes severe spinal stenosis. The spinal cord is markedly narrowed with T2 bright signal occupying about 2/3's of the spinal cord diameter at this level and suggesting myelomalacia. No hemorrhage identified. There is also moderate bilateral foraminal stenosis. At c6-c7 there is 3mm posterior disc protrusion centrally causing mild spinal stenosis and minimal cord flattening. There is minimal degenerative change at the other cervical levels.
Impression: Disc extrusion at c5-c6 causing severe spinal stenosis and cord flattening with myelomalacia and moderate bilateral foraminal stenosis. disc bulging at c6-c7 causing mild spinal stenosis and cord flattening.
I'm 44 years old.
Pre-surgery symptoms were slight neck soreness, numbness left leg/foot and pain done leg, hard to walk, reflexes high, numbness and pain in left arm then moved to the right arm . Hand weakness, leg weakness.
Post-surgery symptoms after 6 months. Increased numbness in left leg and foot, hands so so so sore-hard to make a fist, extreme leg fatigue, increased neck pain, sharp extreme shooting pain in left tricep area , headaches, concentration problems.
I'm wanting to know what my pre-surgery mri really meant and what you think of my post surgery new issues.
They did not fuse my c6-c7 level only the c5-c6.
Thank you so much for any help or thoughts....
Just a quick note. I saw your post about Cervical Meylomalacia and it caught my eye.
First of all I have been thru prior cervical and lumbar surgeries over the years. I have had spine issues now for about 24 years and it seems that I will always have to deal with the issues.
For a long time the most recent complaints was that I was getting a lot of neck pain and radiating pain more so on the left side then the right side from the neck to the shoulder areas. Some times the should pain would stop and I would get more pain centrally in that it felt I was getting a lot of pain in the spine area. It felt like my spine was being crushed. I was getting more headaches. I usually didn't complain of headahces but lately it seemed I was getting more often, nothing severe, yet they were still there. I don't know if I can say they were relted to the cervical issue of not.
My MRI did show myelomalcia. I don't have the MRI report in front of me so I can't say if or whatelse it said. But when I saw my neurosurgeon last year he was certainly concerned about it. In my case he was afraid to touch me surgically because of all the other surgeries that I had been thru & the harrington rods and other health issues were part of the concern as well.
The plan for me at this time was to continue doing Pooe thereapy hoping things didn't get worse. Then see him again. I am schedluled to see him next week where I suspect that he will have a new MRI dont to see if the myelomalacia has stayed the same or if it progressed.
Since seeing him last year I have been on a variety of medications to deal with the pain and finding the one that worked with the least side effects. I was on Oxycodone and Baclofen a muscle relaser but developed complictions from the medication. So I am on Hydrocodone upto 6 tablets per day and a muscle relaxter 3 tablets per day. I just started the dosage so to early to say if it is helping or not.
I wish you well and please keep us posted on hw you are doing