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Old 11-12-2011, 09:06 AM   #1
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Neck pain... mri results...stenosis?

Hello all...
I had an MRI done on my neck because I have been experiencing pain in my neck and shoulders and numbness in my right hand. After my primary doc looked at the results, he referred me to a spine surgeon. I was wondering if anyone had the same things in their mri and what they did to feel better.
Here are a few highlights (or lowlights, I should say)

c3-c4: A very minimal disc osteophyte complex is noted at this level which slightly effaces the ventral aspect of the thecal sac, but does not result in significant central call or neural foraminal stenosis at this level.

c4-c5: There is a right paracentral disc osteophyte complex noted at this level and a small midline extruded disc fragment is noted which extends in a cranial direction within the epidural space along the posterior aspect of the c4 vertebral segment for approximately 4-5 mm. This slightly effaces the ventral aspect of the thecal sac and abuts the ventral surface of the cervical spinal cord causing mild central canal narrowing. Mild flattening of the cervical spinal cord is noted without associated cord edema or myomalacia. There is no significant neural foraminal stenosis appreciated at this level.

c5-c6: There is a bilobed disc osteophyte complex present at this level which slightly effaces the ventral aspect of the thecal sac and abuts and mildly flattens the cervical spinal cord at this level. Mild central canal stenosis is appreciated with AP canal diameter of 8mm. There is no cord edema or myomalacia present. Mild to moderate right-sided neural foraminal
stenosis is noted at this level. The left neural foramen appears widely patent.

So...is this something therapy can fix, or am I looking at something like surgery?

Thanks for reading

Last edited by Jill1201; 11-12-2011 at 02:06 PM.

 
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Old 11-12-2011, 01:40 PM   #2
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Re: Neck pain...mri results...stenosis?

The obvious surgery, based on your MRI, would be a bi-level ACDF (C4-5 and C5-6) to remove the disks. That would be pretty aggressive, though, assuming the radiologist's adjectives (mild, moderate, etc) are accurate. It could well be that a surgeon will look at your images and decide the radiologist was understating things.

Do you have ANY symptoms below the shoulders, particularly in the legs? It's possible, but a little hard to believe, that cord compression/damage would affect only your neck/arm/hand.

The right-hand numbness might be caused by the c5-6 right-sided foraminal stenosis, but the radiologist goes on to say the foraminal opening is still wide open, so that "shouldn't" be it.

I'd sure like to hear what the surgeon has to say. It is not unusual that surgeons are better at reading cervical MRI's than are the radiologists.

As for therapy, I'm skeptical, but skepticism is my default state of mind, and someone else here will hopefully be able to contribute more.

Last edited by WebDozer; 11-12-2011 at 01:41 PM.

 
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Old 11-12-2011, 02:03 PM   #3
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Re: Neck pain...mri results...stenosis?

WebDozer...thanks for the reply. I don't have any symptoms in my legs, except for the fact that I seem to be clumsier than normal. Although, as I type this, I am thinking that my right leg seems to "fall asleep" quite often. I guess I never really equated the two. In your opinion, do you think that Radiologists tend to understate the issues? Also, what is everyone's opinion about chiropractic care for this problem. Is that even a possibility? After proofreading what I typed about my mri, I noticed that I wrote "the neural foramen appears widely patent". It should read "the left neural foramen appears widely patent" Sorry about that. Makes a difference, right??LOL

Last edited by Jill1201; 11-12-2011 at 02:09 PM.

 
Old 11-12-2011, 02:49 PM   #4
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Re: Neck pain... mri results...stenosis?

<<In your opinion, do you think that Radiologists tend to understate the issues?>>

I don't have enough experience to make that kind of judgement. However, I've seen numerous posts here, like yours, where the symptoms and the radiologist's report don't seem to match. I also have personal experience with surgeons who would not even look at radiologist's reports.

<<I seem to be clumsier than normal.>>

That could be material. There are standard tests that docs can give you to test for nerve damage. Perhaps the doc you've already seen is leaving that for the surgeon? It's definitely something to mention to him.

<<Although, as I type this, I am thinking that my right leg seems to "fall asleep" quite often.>>

Depends on what you mean by "fall asleep". If you're not cutting off circulation, then it's a problem. Some people complain of "numbness" and "pins and needles". I have "chills" and sometimes have felt like both feet are in a bucket of cold water. I've also had another rather unpleasant feeling I just call "sick nerve feeling", because nothing else seems to describe it.

Anyway, the leg problems MIGHT be caused by cervical cord damage.

<<I noticed that I wrote "the neural foramen appears widely patent". It should read "the left neural foramen appears widely patent" Sorry about that. Makes a difference, right??LOL >>

It might. At least it makes more sense. So the right-side foraminal "mild to moderate" problem could be affecting your hand.

I would not be surprised if your surgeon sees more of a connection between the MRI findings and your symptoms, or if he suggests a bi-level ACDF. I'd suggest you ask him if you have congenital cervical spinal stenosis, and if a laminoplasty makes sense. He will probably say "a little", and "no"

Last edited by WebDozer; 11-12-2011 at 02:52 PM.

 
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Old 11-12-2011, 02:58 PM   #5
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Re: Neck pain... mri results...stenosis?

Let me add that I would be VERY careful about chiropractic care, at least until you get a go-ahead from a spine surgeon (although the most he's likely to say is "it can't hurt").

That C4-5 disk that has decided to journey up toward your brain (don't worry, it won't get that far) strikes me as something a chiropractor could exacerbate, but that's just my uninformed guess. You REALLY don't want to make that worse, because the farther upwards the disk herniates, the more likely that a surgery might leave part of the disk behind, which you really don't want to have happen.

Last edited by WebDozer; 11-12-2011 at 03:01 PM.

 
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Old 11-14-2011, 03:01 PM   #6
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Re: Neck pain... mri results...stenosis?

Had an EMG done today. Results are normal. My primary dr thought that the numbness might be carpal tunnel. We can cross that one off the list. Should anything that showed in the mri cause an abnormal EMG or is that test for something totally different? Still wondering about the fingers going numb. I have an appt with the spine surgeon tomorrow.

 
Old 11-14-2011, 03:54 PM   #7
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Re: Neck pain... mri results...stenosis?

I can't answer that question. Information for the Spine surgeon, though. As for the hand problem being carpal tunnel, does the doc think that because the EMG has ruled out other causes?

 
Old 11-14-2011, 05:00 PM   #8
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Re: Neck pain... mri results...stenosis?

Sometimes I think that doctors are like car mechanics. They keep "throwing parts" at you hoping that one will fix the problem. My pcp sometimes goes overboard with the testing. I think that maybe when he hears numb fingers, he automatically goes to carpal tunnel. I guess it's a way to systematically rule things out. I never thought for a minute that was the issue, but it's good to know it's not!

 
Old 11-14-2011, 05:54 PM   #9
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Re: Neck pain... mri results...stenosis?

I'm sorry, just so I'm clear, you are saying that carpal tunnel was RULED OUT?

 
Old 11-14-2011, 06:01 PM   #10
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Re: Neck pain... mri results...stenosis?

I assume that it was ruled out seeing how the EMG was normal. Unless it's possible to have a false negative. Medical stuff makes me crazy

Last edited by Jill1201; 11-14-2011 at 06:02 PM.

 
Old 11-14-2011, 06:57 PM   #11
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Re: Neck pain... mri results...stenosis?

Depends on what he was testing for. EMG's can be used for testing for carpal tunnel, OR they can be used for testing for radiculopathies (spinal nerve problems), in conjunction with cervical MRI's. So, if he said the EMG is "normal", was he ruling out carpal tunnel or radiculopathy? I guess he left you with the impression that he didn't think it's carpal tunnel, but what did he think it is? Or did he just say, go see the surgeon (which would imply he thinks it may be a cervical spinal problem)?

Anyway, I presume the surgeon will get the doc's notes, which would render our conversation unnecessary.

Let us know what the surgeon says. Also, I would strongly advise getting more than one opinion, if for nothing other than your piece of mind, so try to resist the temptation to immediately schedule surgery if that's what is suggested. (I made that mistake twice, last Spring!)

Last edited by WebDozer; 11-14-2011 at 07:00 PM.

 
Old 11-15-2011, 02:09 PM   #12
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Re: Neck pain... mri results...stenosis?

Just come from the surgeon's office. She was wonderful and spent alot of time explaining what the MRI report said and how it effects me. She believes I have 3 things going on at the same time:

DDD

Pinched nerve in my neck from the herniated discs which is causing me to "baby" the neck, and therefore not move it.

Cubital tunnel syndrome which is causing the numbness and tingling in my fingers.

She gave me a script for Meloxicam , physical therapy to restore movement and strength to my neck and shoulders, and braces to sleep in for the cubital tunnel syndrome.
She said that there was nothing too worrysome in the MRI. Alot of things that you expect to see on a 41 year old. The only surgery she even mentioned is one that will release the ulna nerve, and only if I begin to lose strength or movement in my hand.
All in all, pretty happy with what she said. Now, if the treatments help..that remains to be seen.

 
Old 11-16-2011, 05:43 AM   #13
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Re: Neck pain... mri results...stenosis?

I hope everything works out for you. A pinched ulnar nerve makes sense. The doc who supposedly ruled out carpal tunnel should have tested your elbow, too.

As I said in my first response, surgery seems pretty aggressive, given your MRI. However, your MRI is at least borderline, in particular regarding the extruded disk fragment and the right-side foraminal narrowing farther down. Something to keep in mind.

 
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Old 11-16-2011, 06:10 PM   #14
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Re: Neck pain... mri results...stenosis?

Quote:
Originally Posted by WebDozer View Post

Depends on what you mean by "fall asleep". If you're not cutting off circulation, then it's a problem. Some people complain of "numbness" and "pins and needles". I have "chills" and sometimes have felt like both feet are in a bucket of cold water.
I thought it was just my imagination and I'm glad that someone else has that feeling of their feet being in a bucket of cold water! My problems start from one side of my groin and go down to my foot. It will feel numb on one side just like it has fallen asleep yet there is not reason for it to feel that way. The weird thing it that it's mainly on the same side of my body that I have the upper body problems.

Do you have any problems with breathing? I have a weird feeling that I just can't describe. It's like some kind of pressure prevented me from breathing at times.

 
Old 11-16-2011, 06:21 PM   #15
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Re: Neck pain... mri results...stenosis?

Yes, if you have spinal cord damage, it is often on one side because the disk herniates more on one side than the other. The cord damage that required me to get my first operation (ACDF) was entirely right-sided - hand, shoulder and leg.

I find it hard to believe that you told a doc about this and was told "it's nothing". Especially the breathing part. She must think you're imagining it.

 
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