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Old 07-25-2012, 08:49 AM   #1
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Help with Understanding my MRI report please...

I would so appreciate any input and explanation anyone might have regarding my symptoms -- and explanation of the following MRI results.

My acute chronic pain occurs in my neck -- and radiates up into the back of my skull. Strong acute pain also occurs across my left shoulder and seems to radiate down into the triceps of my left arm. Various times of the week the entire left arm is 'funny' like the misnamed 'funny bone'....with numbing pain down to the fingertips. I've been doctoring for a year and a half with this -- tried every treatment available. I'm on my way for my SECOND spinal surgeon appt early August.
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FINDINGS: The normal cervical lordosis is mildly reversed. There is mild cervical scoliosis to the left. The
vertebral body heights and alignment are preserved. There are endplate osteophytic degenerative changes with accompanying intervertebral disc space narrowings at the C4-C7 levels. There is a 1 cm hermangioma in the C7 vertebral body. In addition, there is a subcentimeter hemangioma in the posterior C2 vertebal body. Otherwise bone marrow signal intenity is within normal limits.

The cervical spinal cord is normal in caliber and signal intensity.
The visualized posterior fossa is grossly unremarkable.

C2-C3 level: unremarkable

C3 -C-4 Level: there is a posterior central broad-based disc protrusion with minimal endplate dengerative changes, mildly indenting on the dural sac with no spinal cord compromise. Bilateral neural foramina are patent.

C-4 - C-5 Level: There is a minimal diffuse disc bulging with endplate degenerative changes, mildly indenting on the dural sac with no spinal cord compromise. The left neural foramen is mildly and the right neural foramen is moderately narrowed by uncovertebral joints hypertrophy.

C-5-C-6 Level: There is a left subarticular broad-based small disc protrusion with endplate osteophytic degenerative changes, indenting on the dural sac with no spinal cord compromise. The right neural sforamen is mildly and the left neural foramen is moderately narrowed by disc herniation with bilateral uncovertebral joints hypertrophy.

C-6 - C-7 Level: There is a minimal diffuse disc bulging with endplate miimal degenerative changes, mildly indenting on the dural sac with no spinal cord compromise. the right neural foramen is patent. The left neural foramen is mild to moderately narrowed by uncovertebral joint hypertrophy.

C-7-T-1 Level; there is a minimal diffuse disc bulging, slightly indenting on the dural sac with no spinal cord compromise. The left neural foramen is moderately narrowed by the superimposed left foraminal disc protrusion with uncovertebral and facet joint hypertrophy, impinging on the left C8 nerve root. There is also an 8 x 6 mm well-defined cystic lesion in the exit of the right neural foramen, which may reflect a synovial cyst or perineural CSF space enlargement.


IMPRESSION:
1. Mild reversal of the normal cervical lordosis and mild cervical scoliosis to the left
2. C-7 and T-1 left neural foraminal stenosis with Left C8 nerve root impingement
3. C7-T1 right neural foraminal 8 x 6 mm well defined cystic lesion, which may reflect a synovial cyst or perineural CSF space enlargement. Clinical correlation is recommended.
4. Multilevel disc hernations with endplate osteophytic degenerative changes, indenting the durl sac with no spinal cord compromise.
5. C4-5 and C5-6 and C-6-7 left neural foraminal stenoses.

RADIOLOGIST REPORT of MRI, January 16, 2012

 
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Old 07-25-2012, 10:28 AM   #2
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Re: Help with Understanding my MRI report please.....

I wonder about the a connection between the "mild cervical scoliosis to the left" and the fact that the left foramina are "moderately" narrowed at three levels. At all three levels he blames uncovertabral hypertrophy, which makes me think that the uncovertebral joints on the left side are getting overworked trying to stabilize lateral vertebral slippage and that's causing osteoarthritis. Perhaps someone who actually knows a little bit about these things can comment?

Anyway, aside from the pain going up the back of your skull, your symptoms seem to be limited to your left shoulder and arm, which would point toward multilevel radiculopathy. That is, your spinal nerves are being squeezed as they leave the spinal cord and pass through the foramina. This may be due entirely to endplate degeneration and uncovertebral osteophytes. I don't know your age, but this is the kind of thing that could happen to a lot of people and, as I said, I wouldn't be surprised if the scoliosis somewhat exacerbates things.

I would note that the radiologist does NOT say that the nerves are being affected as they pass through the foramina, and he only says the narrowing moderate. We seem to get quite a few people here, though, whose symptoms are consistent with radiculopathy even though the radiologist is far from definitive about it.

I thinking that this may be the kind of thing that can be surgically addressed without resorting to something major like an ACDF. Perhaps some kind of posterior foraminotomy can get at those uncovertebral joints? Maybe that would be enough to make a considerable improvement.

As for the pain going up the back of your skull... the radiologist seems to think that the upper levels C2-3 and C3-4 are OK. I suppose that pain from the left C4-5 foramen could radiate that way. Or maybe it's a byproduct of the scoliosis?

It's good that you're going to see more than one surgeon. What did the first surgeon say?

Last edited by WebDozer; 07-25-2012 at 10:32 AM.

 
Old 07-25-2012, 10:45 AM   #3
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Re: Help with Understanding my MRI report please.....

Thank you ever so much for your description and impressions of the MRI report.

The first spinal surgeon I saw (founding father of the Orthopedic Institute) was about as interested in my case as watching paint dry. He believes that the neve that ?may? be impacted would be the one to only affect the right side of the body -- the side that hardly hurts at all. He gruffly stated that there is only arthritis in the neck causing any problem; and that the left arm is another issue.... possibly still weak from last year's rotator cuff surgery.

I returned to my shoulder surgeon for an extensive 'test' of the shoulder/arm and he does NOT believe the arm/shoulder to be in trouble from the surgery as all the protocol levels and motions are still intact.... He was quick to tell me his answer about this was NOT just because he was the shoulder surgeon -- and his honesty impresses me. This doc wrote up a referral to a different spinal surgeon..... see him early August.

I also returned to my Pain Specialist -- great doc -- to make sure he was 'on board' with the second referral -- and he was very happy with who I am about to meet.

By the way, I'm an active (or used to be) exercise-freak 70 year old -- and this pain is about the only serious thing wrong with me. I am so determined to 'get my life back'..... and I do so appreciate your interpretation of what you saw printed by the radiologist. I realize that only DOCTORS can make the final decision -- but the more opinions and facts I can gather, the better questions, etc. I can ask when the options are laid before me.

Thank you.

 
Old 07-25-2012, 10:52 AM   #4
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Re: Help with Understanding my MRI report please.....

Well, at least "early August" is no longer very far off

I'd suggest researching uncovertebral joints. Perhaps you can get an idea if a leftward scoliosis might increase the chance of osteoarthritis there. Also look and see if anyone is claiming that some "minimally invasive" surgery (like some kind of foraminotomy) can address uncovertebral hypertrophy.

 
Old 07-25-2012, 10:59 AM   #5
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Re: Help with Understanding my MRI report please.....

Keep in mind that NO ONE here is a medical professional and can interpret your MRI....So please don't include anything we say into your treatment plan. You must seek out a Dr. to appropriately read the results and go from there.

I recommend going to the top of the top which is a Board Certified Neurosurgeon. They have the most experience in spine issues...especially with the cervical region.

I have had 3, two-level, cervical fusions so I can completely empathize with the pain and symptoms that come from this.

I would make an appt. with one soon so that you can start on an appropriate treatment plan. The good news is that most everyone after the age of 25-30 starts having disc issues. It's just part of the natural aging process.

And many people...if you were to grab them off the street and do a MRI...it would show these types of "changes". But many people don't have a single symptom....and then others can have all mild readings but have severe pain. So the MRI is just one tool but it takes a skilled MD to do a physical and check your range of motion, listen to your pain complaints, and even do nerve conduction studies to see what is going on.

I also recommend starting a pain journal every day and writing down when it hurts. What type of pain, when it's better during the day, etc. What activities you can/can't do and then read this to the Dr. to better explain things.

Good luck and keep us posted..

 
Old 07-25-2012, 11:01 AM   #6
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Re: Help with Understanding my MRI report please.....

You have mentioned many a term that I need to research prior to meeting my next spinal surgeon. I'll be researching them ASAP............ thanks for the ideas.

You helped clarify many of the points listed by the radiologist -- you're a goodie, Webdozer.

I ?may? get an earlier appt -- this clinic has the best phone system I've ever had the pleasure to attempt. They have a way to press a button, it saves your place in the cue, and they call you back when it's your turn. AND, they really called me back. I've changed my appt. once already as it seems cancellations happen every day -- so I'm gonna keep on trying.

Again, thanks for the great ideas and input.

 
Old 07-25-2012, 11:30 AM   #7
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Re: Help with Understanding my MRI report please.....

I do so understand your statements about 'adopting' what is said here -- and I assure you I am not using any of your opinions as a substitute for seeing another specialist. Every tidbit of knowledge, however, is helpful as they assist in gaining knowledge and asking succinct questions.

I appreciate your thoughts about seeing a Neurosurgeon. There are many opinions 'out there' regarding whether orthopedic or neurology is the correct specialist. I will definitely keep that in mind as I pursue my options and listen to all the explanations of what is the best option for me.

Recently I had a Myelogram and Catscan--- and a nerve conduction test. They are adding to the info that my new specialist will need to study prior to option suggestions. The one good news is that the nerve conduction test indicates zero nerve damage................. and so if there is an option to help release the nerve from its entrapment, the chances of less pain ?may? be a possibility.

I like your idea of a journal -- and plan to begin one immediately. It would give me two weeks to define some specifics for the specialist, rather than only talking in pain generalities. Thank you.

 
Old 07-25-2012, 12:01 PM   #8
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Re: Help with Understanding my MRI report please.....

I agree that there are great people on here and it's a good exchange of ideas/thoughts. Just wanted to clarify about non medical professionals as many people mistakenly think that some boards have "on staff" Drs. who answer questions...

So I'm glad you know the difference

The part about Ortho vs. Neuro is that a Board Certified Neurosurgeon has more training in the cervical region as their speciality is nerves, the brain and spinal cord.

This is just what I have learned through my journey and researched as well. When I first had disc herniations....my Orthopedic Surgeon did injections, traction, and other treatments but when it came to my fusion surgery, he recommended I go to a Neurosurgeon as he said, "I do lumbar fusions and you need someone with more experience than I"...

So it really is all about the Dr. and what they have the most experience with as well as knowledge so just make sure you ask" Either way of who you choose...just make sure they are Board Certified as that is the key.

That is good news that you don't have any nerve damage! Keep us posted on how it goes...

And just wanted to say that the Maine Coon cat is my mom's favorite!! She has owned quite a few over the years as she was born there MEOW! LOL

 
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Old 07-25-2012, 12:33 PM   #9
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Re: Help with Understanding my MRI report please.....

I was able to find the term "Board Certified" directly by the name of my spinal surgeon's name when I researched it online. I know this doesn't answer the question as to whether he or a neuro-surgeon should end up doing any procedure for me.......but, one step at a time. If I have the good fortune to have my orthopedic specialist be as honest as yours was, that would really be something. You are helping me 'walk my journey' with more confidence.

We have 'rescued' 3 Maine Coons in the last 15 years. We lost our first adorable -- big boy, orange/white two years ago. We missed him so much we drove back to the same rescue organization that concentrates on the 'big cats' as they are the last to get rescued. We surely do love our adorables. I'll change the avatar sometime to our black/white big boy -- this photo is of our little girl.....adorable, unbelievably smart and ever so lovable. MEOW.......to you too.

It's been a painful couple of days-- and you have helped me see some 'light at the end of a tunnel'.......with possibilities ahead of me. Good research helps me -- makes me feel as if I am at least doing ?somethiing? to help myself.

 
Old 07-25-2012, 01:51 PM   #10
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Re: Help with Understanding my MRI report please.....

I will be interested to hear what the new doc says. I have an iPhone and iPad app that tracks my pain. I'm not sure if you have either of those. I showed it to my pain doc and she was very impressed.
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Old 07-25-2012, 04:11 PM   #11
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Re: Help with Understanding my MRI report please.....

wow, bb, that app sounds fabulous -- nope, haven't heard of that one....but then i'm a 'slow one' to ******** apps at times. i'll have to look to see if my phone can handle that as a freebie...

glad you are feeling a bit better today --- i hope it continues to improve....

 
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