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hamsta44 06-15-2012 02:01 PM

Mri analysis
 
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In March 2011, I slipped down some stairs on my back-feet first. From that time on I ended up with a severe hunch over, weakening in my left arm and right leg gained calf cramps. I saw the Doc the day after and was X-rayed, given some pain killers and that was that.
By a fluke, while seeing a hand surgeon about another thing, the weakness in my left arm was commented on. It was much worse by now.
I was sent to one of the top neurosurgeons and promptly given an MRI scan.
The results:
Findings:
Cervical spine
Alignment is normal.
No active bone oederna.

C2/3/4/5 No significant abnormality.

C5/6/7 Moderate to severe bilateralneural foraminal narrowing secondary to uncovertebral disc osteophyte complexes. No obvious disc protrusion.

C7/T1 No abnormality.

Craniocervical junction and cervical cord are normal in appearance.
No focal bone lesions. No paraspinal soft tissue abnormality.

Lumbar spine:

Distal thoracic cord and conus are normal in appearance.

L1/2 No abnormality.

L2/3 shallow broad-based posterior disc bulging. No neural compromise.

L3-5 No abnormality.

L5/S1: 3mm anterolistheses secondary to bilateral L5 pars defects. Mild-moderate bilateral neural foiramina narrowing secondary to bulging and anterolisthesis. No focal disc protrusion. No spinal canal narrowing. Mild bilateral facet arthropathy.

No focal bone lesion. No paravertebral abnormality.

Comment:
1. C5-C6 and C6-C7 spondylotic changes associated with bilateral neural foromina narrowing.
2, L5/S1 spondylitic spondylolisthesis associated with bilateral neural foarnina narrowing.

The surgeon suggests fusion of the C5-7 section.

Prior to the fall, I was able to walk normally, ride my bike etc but not now.


What I am wondering is what may be instore for the future after the fix,

Also what it is possible to do afterwards.

I forgot to add, that in Jan this year, I saw a chiropractor who managed to get me able to stand straight again and had a session of deep tissue massage which helped aleviate the cramps

jennybyc 06-15-2012 02:54 PM

Re: Mri analysis
 
Basically, there are 2 major problems we can get in the neck. One is compression of the spinal cord itself and the other is compression of the spinal nerves that come off of the cord and go out to the body. You have the latter.

You have bone spurs that have built up enough at C5,6 and 7 that they have blocked the nerves that leave the cord and go out to your body. they rate this blockage with the terms....minimal, mild, moderate and severe and you have reached the severe level...that is the worst....unless they can't see the nerves at all.

Most spine surgeons will elect to operate when you reach the severe level so as to prevent nerve death to the arms. The ACDF they suggested is pretty standard although you may also qualify for a "laminoplasty" that does not involve fusion of the bones so you keep a full range of motion. Actually, since it's not from a disk but bone spurs, the laminoplasty may be even better than an ACDF but the big problem is finding a spine surgeon who does it....only been around for the past 10 years and it's taking forever to catch on in the US.

Your lumbar is not bad but has a similar problem but not yet bad enough to qualify for surgery. The spondylolisthesis may actually be something you were born with....about 60% of the spondy's they find in people are congenital. they don't fix those until they are much worse than what you have.

Get your neck fixed first and then see how you feel. But you may want to ask your doc about a laminoplasty and if he doesn't do them, think about getting a 2nd opinion from someone who does do them.

hugs...........Jenny(fused C3 to T1)

WebDozer 06-15-2012 02:58 PM

Re: Mri analysis
 
I'm a little baffled by your report. He says there are disk/osteophyte complexes big enough to severely impair your C5/6/7 foramina, but NO disk protrusion? OK, if there's NO disk protrusion, why does the surgeon want to take the disks OUT?

Can you describe the weakness in your arm? For example, is it biceps but not triceps, or vice versa?

Following up on what Jenny said, I wonder why those uncovertebral osteophytes cannot be addressed directly, without either an ACDF or a laminoplasty.

Also, has anyone explained the relationship between your fall and the osteophytes (as these tend to build up over years, rather than resulting from trauma)? I suppose what happened is that the osteophytes were already about the cause problems and the fall pushed one or more of them over the edge.

jennybyc 06-15-2012 04:51 PM

Re: Mri analysis
 
That would be my thinking web...that they were there already and about to be a big problem. But I don't think they can get to osteophytes inside the canal so a laminoplasty would be better than an ACDF which removes the disk and fuses the 2 vertebrae but does nothing to remove the osteophytes. Maybe the doc thinks the osteophytes would be less of a problem and stop growing with a fusion but in my case, that did not happen at all...they kept growing.

Actually, a bi-lateral foramenotomy might be better than anything....fairly minor surgery compared to a fusion. An ACDF seems like tremendous over kill and won't fix anything that is wrong.

Hamsta.....you have some questions to ask your spine doc!

Jenny

WebDozer 06-15-2012 05:12 PM

Re: Mri analysis
 
I thought I must have been missing or misunderstanding something in the report, because fusion just didn't make any sense to me, but if Jenny sees it the same way, then it's not me.

There's a possibility that the report itself is wrong. Two surgeons have told me they don't even look at radiologists' reports; they just look at the images. Maybe the surgeon you saw read the images very differently than the radiologist did.

If not, though.... I would really want that surgeon to explain the rationale behind fusion, as opposed to laminoplasty or foraminotomy. You don't have a kyphotic cervical spine, which is one contraindication for laminoplasty. You might have to have the C7 lamina included in the operation, and maybe that's what your doc is concerned about. Or... maybe he just doesn't know how to do laminoplasties.

Foraminotomies would, of course, be by far the least invasive and least difficult operations, with the fastest recovery and no permanent pain or loss of mobility.

Hamsta, I know what it's like to have a surgeon tell you that you need such and such a surgery, and then you just say, OK, let's schedule it. I've done that several times myself. Still, I really think you need to educate yourself a little about the structure of your cervical spine, where and what are the problems, and what are the arguments for and against each of the three surgeries mentioned.

You need to have an informed conversation with this surgeon, and you need to talk to TWO other surgeons. Seriously.... TWO.

BTW, a few years back, I went to pick up a twelve-pack of soda with my left arm and couldn't do it. Just like that, from one day to the next. My left biceps and deltoid lost maybe 3/4 of their strength. After a fair amount of frustration with neurologists and surgeons, I had a left C5 foraminotomy done. I was out of the hospital that same afternoon, never filled my pain prescription, and got most/all of my strength back right away.

hamsta44 06-15-2012 09:49 PM

Re: Mri analysis
 
The weakness is mostly in the left arm, but the right is not unaffected- it is better but not much.
The left arm cannot be lifted more than 50 degrees from straight down. By bending at the elbow, the hand can be raised to about my ear.
The hand has very little grip at all. I drop items very easily and without warning. Eating is difficuilt in that holding a fork is hard.
Does that help?
Also, and I forgot this before, when carrying/lifting/walking up a grade, iI find that my chin drops and I start to stoop-same when tired.
I appreciate all your views so I can look at all the options in a more informed light. Keep them coming.

WebDozer 06-16-2012 07:10 AM

Re: Mri analysis
 
<< The left arm cannot be lifted more than 50 degrees from straight down >>

If that were due to shoulder pain, it would probably be a rotator cuff injury. If it's lack of strength, however, it would likely be from denervation of shoulder muscles, particularly the deltoid.

The fact that your problems are bilateral in your arms and possibly also involve your legs opens the possibility that they are not spinal in origin. However, the radiologist said that you have "severe" foraminal narrowing, and I would translate "severe" as "fix this!".

Of course, I'm just a slightly-educated amateur who has a little more personal experience than he'd like, and the people for serious consultations are the surgeons. Note that I said "people", not "person". Get it?

hamsta44 06-16-2012 02:40 PM

Re: Mri analysis
 
I think that the lack of movement stems from the nerves not communicating correctly with the muscles and, as you said, the deltiod has been affected. This, I hope, will remedy itself once the neck is fixed. Does this sound about right?
As for rotator cuff, I had this on the right years ago and the symtoms were quite different. It can right once fixed.

WebDozer 06-16-2012 04:23 PM

Re: Mri analysis
 
Supposedly, the longer a nerve is impaired, the lower the chance of its recovery. I don't know if that supposition has been statistically supported, though, or is only anecdotal.

Anyway, it would seem pretty clear that at least one of your spinal nerves (left C5??) needs to be freed up. Likely more than one. The big question is how to do it. We (Jenny and I) do not understand the rationale behind fusion, though, as it would seem to fix something that isn't broken, while failing to address the real problem.

I hope you can get it straightened out, and soon...

barbarakym 06-21-2012 10:46 AM

Re: Mri analysis
 
This is my first post. I just had an MRI done yesterday and won't see the Dr for a couple more weeks. I would like to know what all this means. On xrays he said I had severe degenerative arthritis of the lumbar region. MRI is of the lumbar region:

REPORT:

Anterior and posterior osteophyte formation with disc desiccation and disc space narrowing seen at L5-S1. Disc desiccation is seen throughout the rest of the lumbar spine. Mild anterolistesis lf L4 with respect to L5 is noted without pars interarticularis defect. The conus is at T12 without abnormal signal at the distal cord.

L5-S1: 4-5 mm disc protrusion with posterior osteophytes results in mild bilateral foraminal narrowing and possible impingement on the exiting nerve roots bilaterally. No central canal stenosis. Mild facet hypertrophy is noted bilaterally.

L4-5: 1-2 mm broad-based disc protrusion with Grade I spondylolisthesis without foraminal narrowing, central canal stenosis or impingement on the exiting nerve roots. Moderate facet hypertrophy is seen bilaterally and moderate thickening of ligamentum flavum is seen on both sides. No central canal stenosis.

L3-4: 2 mm broad-based disc protrusion with a zone of high signal intensity and minimal anterolisthesis lf L3 with respect to L4 are noted without foraminal narrowing, central canal stenosis or impingement on the exiting nerve roots.

L2-3:2 mm disc bulge is seen asymmetric to the left without foraminal narrowing, central canal stenosis or impingment on the exiting nerve roots.

L-1-2 and T12-L1: no disc bulge or protusion

T11-Tqw: 2-3 mm central disc protrusion seen without foraminal narrowing or impingement on the exiting nerve roots.

Any idea how this might relate to my severe lower back pain and weakness and swelling and burning on standing in my feet?

WebDozer 06-21-2012 10:49 AM

Re: Mri analysis
 
Barbara... two suggestions, if you don't mind.... (1) make your post into a new thread so it will get more attention and (2) also post it on the Back Problems board, where there is a lot of lumbar expertise.

hamsta44 06-27-2012 12:18 AM

Re: Mri analysis
 
Well I go to see the surgeon, tomorrow, inpreparation for the big day, hopefully next week. It is scary however I am not the first to have it. I have read alot about this preceedure in the past few days and feel positive about it. Thanks for all your information that you have given.

kenzibenzi 06-27-2012 10:25 PM

Re: Mri analysis
 
Good luck! Let us know how it goes!

hamsta44 06-27-2012 11:46 PM

Re: Mri analysis
 
Will do. Thanks for all your support.

WebDozer 06-28-2012 04:15 AM

Re: Mri analysis
 
Hamsta - I hope you will discuss with the surgeon how doing ACDF's will address the osteophytes problem (see earlier posts by me and Jennybyc)


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