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Old 06-26-2012, 05:33 PM   #1
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Question Need help with MRI results

This question was originally posted to the Back Problems forum, but it was suggested that I try this forum as well. So here goes again (Courtesy of copy & paste)

I just got the results of my MRI in the mail and I am in need of some explanation/interpretation of the results. I have an appointment July 12th, but I would like some information before then. Here is the exact text from the letter:


PROCEDURE: MRI CERVICAL SPINE W/O CONTRAST

COMPARISON STUDY: None

REASON FOR STUDY: neck pain with right arm numbness

TECHNIQUE: MRI of the cervical spine was performed without IV contrast.

The following sequences were obtained:

PROTOCOLS: Sagittal STIR, Sagittal T1, Sagittal T2, Axial T2

FINDINGS:

Alignment is normal. No compression fracture. Signal within cord is normal. The visualized brainstem and posterior fossa are normal. Prevertebral soft tissues are normal.

C2-C3: Normal

C3-C4: There is bilateral foraminal narrowing because of shorts pedicles and mild uncovertebral hypertrophy.

C4-C5: There is a small broad disk bulge producing mild central stenosis. There is bilateral foraminal stenosis secondary to short pedicles and uncovertebral hypertrophy.

C5-C6: There is a broad posterior disk osteophyte complex along with bilateral uncovertebral hypertrophy producing significant central and bilateral foraminal stenosis.

C6-C7: There is mild foraminal narrowing bilaterally because of short pedicles.

C7-T1: Normal

Impression:
IMPRESSION:
1. Significant central foraminal stenosis at C5-6.
2. Mild central stenosis at C4-5.
3. Multilevel foraminal narrowing because of short pedicles and uncovertebral hypertrophy.

Permanent images of this exam have been recorded.



Parts of it I understand, and other parts are no so clear to me, and the picture as a whole is far from complete in my mind. It is probably better that I get a fresh take on this than try and bang my head uselessly trying to piece it together from all over the internet. Any help with some preliminary interpretation is greatly appreciated.

Thanks,
Ed

 
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Old 06-26-2012, 06:43 PM   #2
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Re: Need help with MRI results

<<C4-C5: There is a small broad disk bulge producing mild central stenosis.>>

The C4-5 disk is bulging backward a little into the spinal canal and creating a condition of stenosis (abnormal narrowing).

<< There is bilateral foraminal stenosis >>

The foramina - the holes in the spinal cage through which the cervical nerves leave the spinal cord and head into the shoulders/arms/hands - are being abnormally narrowed on both sides.

<< secondary to short pedicles >>

The pedicles are part of the sides of the spinal structure, sort of "spacers" between the vertebrae and the back of the spine. Yours are too short, and that means both that your spinal canal is of less then optimal size (hereditary spinal canal stenosis) and your foramina are too small, too. This is not due to deterioration; you were born this way (as was I). However, you have less "room for error", as it were.

<< and uncovertebral hypertrophy. >>

Your uncovertebral "joints" - structures on the sides of the vertebra that help hold the vertebra together when bending - are laying on extra bone ("bone spurs" or "osteophytes") and this extra bone is intruding into the foramina. Because of the short pedicles, any intrusion is more likely to affect the nerves passing through the foramina.

<< C5-C6: There is a broad posterior disk osteophyte complex >>

Bone spurs growing off the backs of the C5 and C6 vertebrae immediately above and below the C5-6 disk. Likely due to long-term wear and tear. May be accompanied by a bulging disk.

<< along with bilateral uncovertebral hypertrophy producing significant central and bilateral foraminal stenosis >>

Often, radiologists use a range of minimal/mild/moderate/severe to describe degrees of deterioration. We'd have to ask this radiologist where in that scale he means for "significant" to fall. Since he's not here to be asked, I'll guess it's between moderate and severe. "Central stenosis" means that your spinal canal is being narrowed.

I would note here that he doesn't say if the central stenosis is affecting the spinal cord. He should say if it does, but he should also say if it doesn't. Because of your hereditary spinal canal stenosis (my interpretation) due to short pedicles, any intrusion into the canal is more likely to affect the cord.

If there's one thing I think you should take away from this, it's an understanding of what "short pedicles" are and what that means in the context of your spinal problems, and also what it means for possible surgical intervention.

Last edited by WebDozer; 06-26-2012 at 06:54 PM.

 
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Old 06-29-2012, 06:52 PM   #3
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Unhappy Re: Need help with MRI results

Just saw my GP 2 days ago, and he said the neurologist sent my MRI to a neurosurgeon, and the neurosurgeon said he want to see me quickly before the holidays, and has me going in on July 3rd. My GP also told me that the neurosurgeon said that I'm a good candidate for surgery.

So with out even going to the neurosurgeon it looks like they are telling my that it's going to be surgery, just how extensive the surgery is is the question. That should be answered on July 3rd.

BTW: I'm 39 years old.

UGH! Now I'm starting to feel like a pressure cooker about to blow it's lid! I have several other health problems as well. The list of witch is:

HIV - 17 years
Neuropathy - 17 years
CKD Stage 3 [currently] (Chronic Kidney Disease) - 33 years
MRSA infections - 10 years

And several other more minor problems. The grand total on medications to date to treat my various problems is currently 19 meds.

There are a lot of fun factors the doctor is going to have to consider a bit before any decisions can be made.

As I get more info from the docs I'll try to post them soon as I can, see if there is anything I don't really understand even with the docs explanation, and see if you guys may be able to shed light on my situation.

 
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Old 06-30-2012, 09:16 AM   #4
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Re: Need help with MRI results

Back to the short pedicles.... you seem to have hereditary canal stenosis. 10-1 the surgeon will recommend an ACDF, but you might want to look into laminoplasty.

 
Old 06-30-2012, 09:35 AM   #5
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Re: Need help with MRI results

Since you have multilevel cervical disease, it is important to establish which level is causing your pain. Obviously the worst disease is at C5-6, which would likely be the culprit, but the MRI findings, distribution of pain in the dermatomes must be coordinated. There is a test that can be done under fluoroscopy to reproduce the pain by stimulating each level separately to make sure they address the appropriate areas when doing surgery. They typically don't like to fuse more than one level, but can open up the foramen at other levels to relieve the nerve impingement and remove disc material pressing on the canal/cord/nerves where needed. I've had this surgery, and thought it wasn't that bad, at least not compared to my lumbar surgeries for the same problems. The nuisance of the post op collar is the worst thing, which is temporary, and worth it if you are then pain free.

 
Old 07-02-2012, 07:30 PM   #6
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Unhappy Re: Need help with MRI results

Just a few hours until I get to see my NS, and I am definitely feeling lots of apprehension about my visit tomorrow. I'll just hope that things are not too serious. So far I have been able to keep from getting overly stressed and worrying, but with less than 14 hours I am definitely feeling it now.

Anyway just had to get that down and get a little bit off of my mind.


I'll be sure to get as much information I can from his office, MRI, chart notes, etc, and post the pertinent parts.

Well that's about all I have for now, just a mini venting. I think the big venting will be tomorrow after the NS. Until tomorrow then!!!

 
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Old 07-02-2012, 07:32 PM   #7
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Unhappy Re: Need help with MRI results

Just a few hours until I get to see my NS, and I am definitely feeling lots of apprehension about my visit tomorrow. I'll just hope that things are not too serious. So far I have been able to keep from getting overly stressed and worrying, but with less than 14 hours I am definitely feeling it now.

Anyway just had to get that down and get a little bit off of my mind.


I'll be sure to get as much information I can from his office, MRI, chart notes, etc, and post the pertinent parts.

Well that's about all I have for now, just a mini venting. I think the big venting will be tomorrow after the NS. Until tomorrow then!!!

 
Old 07-02-2012, 07:37 PM   #8
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Re: Need help with MRI results

You're not gonna get any sleep at this rate. Try and relax. I know it's easier said then done. I'm facing the same anxiety, only my appointment isn't until the 11th. Good luck to you. Hopefully the news will not be as bad as your anxiety! Looking forward to your next post. Now close your eyes and go to your happy place...lol. Sweet dreams!!!

 
Old 07-02-2012, 07:40 PM   #9
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Re: Need help with MRI results

remember... short pedicles - hereditary canal stenosis - laminoplasty

 
Old 07-02-2012, 09:40 PM   #10
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Re: Need help with MRI results

Quote:
Originally Posted by kenzibenzi View Post
You're not gonna get any sleep at this rate. Try and relax. I know it's easier said then done. I'm facing the same anxiety, only my appointment isn't until the 11th. Good luck to you. Hopefully the news will not be as bad as your anxiety! Looking forward to your next post. Now close your eyes and go to your happy place...lol. Sweet dreams!!!

That's what I have a running prescription of Klonopin for!!! I'll just have a nice long soak, a Klonopin, and think positive about tomorrow morning as I slip in bed for a peaceful nights sleep.

Well it's off to run the bath. I'll be sure to post the results of my NS appointment as soon as we have digested them a bit ourselves.

 
Old 07-02-2012, 09:52 PM   #11
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Re: Need help with MRI results

Quote:
Originally Posted by WebDozer View Post
remember... short pedicles - hereditary canal stenosis - laminoplasty
I'll be sure to put those items on my list of questions for the NS. So far I have put together a lengthy list of questions for him.

Thanks for the advice!!

 
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Old 07-03-2012, 07:52 AM   #12
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Talking Re: Need help with MRI results

Well we are about to head out for my appointment with the NS in a little bit. After we have the appointment/consult/whatever I'll probably need a while to sort out all the information. BUT I will post the results/decision as soon as I can.

UGH! The waiting for last few minutes before we get out of here is really getting me psyched up. Well anyway, I'll definitely be posting the results tonight!! Until then.....

 
Old 07-03-2012, 02:58 PM   #13
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Smile Re: Need help with MRI results

The office visit:

The DR spent about 1 hour explaining what the radiologists impressions mean, went over the MRI with us for about 7 or 8 minutes, explained everything in detail, went over parts, answered all our questions thoroughly, gave me some literature, explained the literature and expanded on it, and was genuinely a really nice, helpful, NOT condescending, PERSON!!!

The MRI and his impressions of it and what needed to be done were much better than I was thinking (You always over think these things!). Anyway he said basically that an ACDF at C5-C6 using an allograft and a foraminotomy on several levels. The spinal cord is very slightly pushed on by the C5-C6 disk and osteophyte complex, but no problems with the cord, and the ACDF of C5-C6 will fix the tiny bit of pressure on it.

Other than that the MRI looked pretty good, might have some problems with my C4-C5 in the future, but hopefully not for a while yet.

He said that a laminoplasty would not be a very good option because all the the materials pushing on my nerves are in the anterior. The Discectomy is needed as it will just continue bulging. The DR said the average recovery time for this is about 4-6 months, soft collar if needed for comfort, weight limited to 5 lbs, then 10, up to a limit of 35lbs, and not a bit more for the rest of my life to make sure I don't make things worse.

I also made sure to request a copy of my MRI. The nurse said it takes about 7-10 days to get the paper pushed, then the disk made and sent either to the DR office for me to pick it up, or it can be mailed to me.

Ummm... It turned out to be better than I thought as far as problems with my neck. Which makes me more relaxed and accepting of what needs to be done. Plus his GREAT "bedside manner" and personality really helped to get rid of my nervousness/fear/anticipation. He was also highly recommended by a good friend whose dad had surgery.

Guess that is about all for now. If you have questions about the visit or anything really just post and I'll do my best to reply...

Thanks!!

Ed

 
Old 07-03-2012, 03:25 PM   #14
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Re: Need help with MRI results

That's great news, congrats! It's not great that you need this surgery, but it is great that you are much more at ease now and things aren't as bad as you thought they would be. Best of luck to you and do keep us posted. Do you have a surgery date yet?

 
Old 07-03-2012, 04:39 PM   #15
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Cool Re: Need help with MRI results

Quote:
Originally Posted by kenzibenzi View Post
That's great news, congrats! It's not great that you need this surgery, but it is great that you are much more at ease now and things aren't as bad as you thought they would be. Best of luck to you and do keep us posted. Do you have a surgery date yet?


Yeah, I'm soooooooo relieved that it's a single level ACDF. Faster recovery, and better ROM than multiple levels makes it much easier to accept the fact I need surgery. No surgery date yet as I have to co-ordinate with my partners schedule for this summer. As soon as I get a date with the DR I'll be sure to post it. And I know the anxiety will start up about the surgery too.

Thanks for being there kenzibenzi, WebDozer, and all the other guy/gals!!! It's great to have a place where you can get some answers in English, and some moral support through the whole diagnosis and resolution, and just vent if needed!!!

 
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