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Old 01-22-2012, 03:32 PM   #1
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MRI = cord compression of ventral margin?

Hi all -

I've been posting a lot recently on the MS board regarding recent concerns that may be MS related. However, my discussion and questions ultimately seemed more appropriate for spinal cord disorders. So hopefully you can help me understand recent symptoms and my follow-up MRI observations (have not seen the orthopedic surgeon to discuss the results yet). I had a few concerns that I thought you could help me understand before my appt tomorrow to help me ask the right questions, and to learn about other experiences, treatment options, etc.

I'll try to make a long story short. History: fractured C6-7 in 1995, no problems really until 2009. Initial exam revealed positive Hoffmann's sign. While MRI did not show any noted cord compression several herniated discs, bulges and bone spurs were observed. After PT didn't help at all or any other conservative treatments, surgery was the only option.
The as quickly as the pain started, it just stopped and I didn't have the surgery.

Fastforward to Last Sunday. After approx 30 mins of waking up I suddenly had dull aching pains and pins and needles *****ling on all of my extremities. The neck pain was not made worse or lessened by any particular position. And in fact, seemed worse when I was relaxed and sitting down. Rotation didn't affect the pain at all. It hurt steadily no matter what I did. Thankfully I had some pain meds left over from a prior surgery or I don't know how I would've made it through the day. By Tuesday it had turned into more of a "crick" in the neck feeling that I had experienced in 2009. The Sunday experience was the worst I've ever felt, next to the fracture itself.

I saw an ortho who ordered another MRI. I reviewed the images and was not surprised by anything I saw, as it is very similar to the MRI in 2009. However, it is a little more advanced in some areas and I have additional symptoms that I wondered if any of you could relate to.

Aside from the bulges, spurs and herniations at C 4/5 and 6/7, which are clearly seen on all sagittal images; there appears to be compression along the same areas of the cord but only in the ventral margin (the white lining along the cord), not the dura (or gray matter). This is even more clearly seen in the axial slices around the same areas but actually looks worse on those images than the sagittal slices. Does anyone know if compression of the ventral margin is even anything to be concerned about at all? If so, is it typical that this would ultimately extend into the actual cord itself? Also, can compression of the ventral margin cause the tingling and numbing that I'm feeling now?

Finally, I have also been experiencing - now this is pretty embarrassing - "incomplete evacuation" during a bowel movements. I have a host of digestive disorders so I just assumed this latest issue was somehow related to that. However, most of the literature that I've found about incomplete evacuation during a BM talks about the "sensation" of incomplete evacuation, and my experience is in no way a "sensation;" it's for real. I didn't think really much about it until I saw that this might somehow be related to some type of neurological issue. Has anyone experienced anything like this in relation to a cord disorder or injury?

Anyway, any advice or shared experience is welcome. I like to arm myself with knowledge before doc visits so I will make sure to ask questions i may not have thought to ask, etc.

Thank you all so much!!

 
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Old 01-22-2012, 04:28 PM   #2
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Re: MRI = cord compression of ventral margin?

You seem to have zeroed in on the potential problem area. However, if it's just the spinal fluid that has been pushed away - and the cord itself doesn't seem to be flattened or indented - then this would not SEEM to be an immediate concern.

Your symptoms tell a different story. It's plausible that they are due to cord compression. I don't know anything about MS, or other alternative explanations. Do some arm/shoulder muscles seem to be affected more than others? Triceps and not biceps, for example? How about your fingers? All/none/some of them?

 
Old 01-22-2012, 05:06 PM   #3
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Re: MRI = cord compression of ventral margin?

Hey there and thank you so much for your reply. It really helps to hear that compression of the spinal fluid alone isn't an immediate concern. On the sagittal images (the very mid-slice) there doesn't seem like any of the cord is being compressed; however, the axial images seem to show areas where the herniated discs actually touch the cord and in some cases the cord looks potentially compressed, although I am by no means an expert on what I'm seeing and may be completely wrong in my interpretation, which would not surprise me at all LOL.

I cannot adequately localize specific areas of pins and needles other than there has been a "strip" down the front of my right arm to my middle finger that has felt like a shock. My lower extremities, both feet, often get tingly. I haven't felt any numbness really except for in my legs. Also, my lower back and between my shoulder blades "cramp" up and spasm a LOT. My back gets so bad sometimes I can't straighten it when I stand up. It's weird tho because I have always attributed my lower back pain to lack of exercise and stomach muscle strength than anything else. It feels like muscle spasms while my neck feels like aching bone. That's the only way I can describe it. As far as arm strength, all seems to be fine. Recently I've started to also exhibit symptoms of restless legs syndrome. I had always thought it was such a quirky questionable diagnosis until I felt it, assuming that's what I'm feeling. It's like my leg muscles on my thighs and in my hips feel like their "crawling" and it's SO annoying. It's a very peculiar feeling and very uncomfortable. This and the lack of strength in my rectum and inability to empty my bowels seems to be the most recent developments that have me confused and concerned.

Probably unrelated but disconcerting is the extreme bouts of fatigue I've been feeling. It's happening while I'm driving and there's no rhyme or reason to its onset of symptoms. But I'll be wide awake and suddenly be overwhelmed with the need to close my eyes and fall asleep. And I can NOT stop it. I've had it happen while driving several times and at work once where I actually had to go into the bathroom and close my eyes before I passed out at my desk. It's awful and something I've never experienced before. It would seem related to lack of sleep but it doesn't seem that way. It will happen after a great night's sleep, and won't happen after hardly any sleep at all. I've even considered narcolepsy. (O.o)

I just have a whole host of related and/or unrelated symptoms and I don't know what to make of it. Who do I see? One doctor or several doctors? I'm
So confused. And I'm only 38. So weird!!!

 
Old 01-22-2012, 05:25 PM   #4
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Re: MRI = cord compression of ventral margin?

That's quite an extensive and varied list of symptoms. The middle-finger thing is your C7 nerve, quite likely, coming from the C6-7 level.

A lot of your other symptoms don't really sound like spinal trouble, although hopefully others here with greater experience than mine can contribute on that score.

I suppose you got sent for the MRI by a physiatrist or GP or somesuch? Wouldn't he have the best idea of whom to see next? Neurologist or rheumatologist would be my guess.

Sorry I can't be of more help...

 
Old 01-22-2012, 07:22 PM   #5
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Re: MRI = cord compression of ventral margin?

I do see a GP for a bunch of digestive disorders including GERD for 20 years and now all the after effects of life-long exposure to stomach acid and what it did to my esophagus; but no, it wasn't he who ordered the MRI. I am seeing an orthopedic surgeon about the spinal issues, and have an appointment at UT Southwestern Medical Center to see a neurologist in April to discuss these other symptoms. The inability to fully "expel" my stools and chronic constipation has been linked to symptoms of neurological disorders, and the intense fatigue, the RLS, etc, are some symptoms of MS - hence the reason I have been posting on their site too. I should know more - I hope - from the ortho tomorrow and I'll definitely keep you guys posted on what the radiologist reported on my MRI. And my neuro is also going to take a look at my cervical MRI and order a brain MRI as well. Should have a LOT of answers in April. At least I'd better!!! Lol

Last edited by gav_73; 01-22-2012 at 07:24 PM.

 
Old 01-22-2012, 07:57 PM   #6
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Re: MRI = cord compression of ventral margin?

I'm interested in what your followup tells you. If you do post, please keep it on this thread...

 
Old 01-23-2012, 04:35 AM   #7
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Re: MRI = cord compression of ventral margin?

Sure thing WD. :-D

 
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