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Old 08-05-2012, 11:04 AM   #1
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Unhappy Help reading my lumbar and cervical MRI

I wonder if anyone can explain this in layman's language and describe any treatment possibilities, including surgery.


MRI results:

Impression:

Multi-level degenerative changes in the cervical and lumbar spine, as decribed below.
Mild to moderate disc bulges and multi-level neuroforaminal narrowing noted in the cervical spine, worse on the left at C5-C6 and C6-C7.
T2-T3 and T3-T4: mild posterior disc bulges
Multi-level disc bulge in the lumbar spine, with annular fissures and disc protrusion/extrusion causing partial effacement of the subarticular recess as on the left at L3-L4 and L4-L5, with potential for nerve irritation at these levels. Mild narrowing of the spinal canal at L2-L3 and at L3-L4.

Details:
C3-C4: No disc bulge. Uncarthrosis , resulting in mild left neuroforaminal narrowing .
C4-C5 : No disc bulge. Bilateral uncarthrosis resulting in bilateral mild neuroforaminal narrowing , worse on the right .
C5-C6 : minimal posterior disc bulge, resulting in mild indentation of the thecal sac, but no significant compression of the spinal cord. Bilateral uncarthrosis , resulting in mild right and moderate to severe left bilateral neuroforaminal narrowing.
C6-C7, moderate posterior dics osteophyte complex is indenting the thecal sac resulting in mild spinal canal compression with no mass effect. Bilateral uncarthrosis , resulting in moderate to severe bilateral neuroforaminal narrowing, slightly worse on the left .
T2-T3 and T3-T4: mild posterior disc bulge, resulting in mild indentation of the thecal sac, but no significant compression of the spinal cord or neuroforaminal stenosis.
Evidence of degenerative disc disease from L2-L3 to L4-L5.
L2-L3: mild diffuse disc bulge and small posterior annular fissure, flattening the anterior thecal sac and causing mild spinal stenosis. Bilateral hypertrophic facet degenerative changes with mild ligamentous thickening noted, resulting in no significant neuroforaminal narrowing.
L3-L4: mild diffuse disc bulge with superimposed left subarticular disc extrusion with minimal inferior subligamentous migration, causing partial effacement of the left subarticular recess. There is mild spinal stenosis. Bilateral facet degenerative changes are noted, resulting in no significant neuroforaminal narrowing.
L4-L5: there is mild diffuse disc bulge with superimposed with mild broad based central protrusion, indenting the anterior thecal sac with associated posterior annular fissure. Moderate bilateral facet degenerative changes are noted, however, there is no specific spinal canal or neuroforaminal narrowing. (This is strange, as a previous MRI taken in 2003 showed moderate spinal stenosis.) The bulging disc appears to abut the left exiting L5 nerve root in the subarticular recess, with potential for irritation.
L5-S1: no significant disc bulge, spinal canal or neuroforaminal narrowing. Bilateral facet degenerative changes are noted at this level.

 
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Old 08-05-2012, 11:13 AM   #2
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Re: Help reading my lumbar and cervical MRI

Obviously we are not medical professionals and you should rely on your own Dr. to interpret these results and go over them with you....Have they not done this yet?

When were the MRIs done and when is your next appt. with your Dr.?

The main thing I would recommend is seeing a Board Certified Neurosurgeon or BC Orthopedic surgeon.

The key part in any report is that they use terms of severity from mild, moderate, to severe. Thankfully most all of yours are mild..

Pretty much anyone over the age of 25 is going to start having degenertative disc issues and changes in their spine. The older we get....as well as depending on the level of activities we have done in our life from hobbies to jobs will affect our spine as well.

So a MRI is just one tool to see what is going on as some people can have huge changes in their spines and even herniations and never know it if it doesn't affect the nerve or cord space and it goes away on it's own. Others can have minimal changes but great pain if it's affecting nerves.

The only level where there is "moderate" activity is in the levels between C6-C7...Osteophytes are bone spurs...

As I asked earlier...I'm curious when these were taken....What symptoms are you having?

What treatments both medicinal and non medicinal have you tried yet?

 
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Old 08-05-2012, 11:40 AM   #3
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Re: Help reading my lumbar and cervical MRI

Ali - I will give you the best answer I can, but could you please first describe your symptoms?

 
Old 08-06-2012, 10:42 AM   #4
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Re: Help reading my lumbar and cervical MRI

Hi Ilovemy cute dog and Webdozer,

I’m hoping the surgeon I see later this year tells me he can fix this. I'm told he may consult with a Neuro Surgeon first. So, I probably won't know what he can do for me for another 12 months- Ugh!!! For the last 30+ years, I have been using chiropractors and/or physiotherapy with traction. I'm currently on Celebrex 200 mg 1x/day and Elavil 25 mgs at bedtime. I had used Meloxicam instead of Celebrex until last week.

Realize my MRI was taken laying down so the compression on the nerves is worse when I'm vertical -ie: as laying flat is the best position for me to get relief!

Here's my symptoms:

1. Neck: Regarding the nerve damage at C5-C6 and C6-C7, this causes many muscle spasms (“knots”) into my traps, all around my shoulder blades, around my chest and down my arms into my hands and fingers. The left side is slightly worse than the right. The knots in my traps and around my shoulder blades are very large and painful. They are hard to manage. Massage and Active Release Therapy helps for only a few hours.


2. S like curve (Upper Back): This leads on up into the neck further adding to its problems. The cause is the tilted pelvis- see # 5 below.

3. Twist in my Upper Back: The last vertebrae in my upper back is slightly twisted and results in one of the ribs popping out of place. It causes a huge (painful) bulge in the muscles adjacent to the damaged disk and rib and pain around to the side of my rib.

4. Lower Back: This damage results in a lot of pain in my lower back, hips and down my legs into my feet. I have suffered with this injury since my teens. The saving grace for me is that it never goes down both legs at the same time. The right is the worst and they call it sciatica as it is likely from the SI joint problem (see below). When the left is affected, the pain seems to travel along a different pathway down my leg.

5. My pelvis is badly tilted. It is almost an inch higher on my right side. This led to the S curve in my upper back and is part of the reason for some of my hip and leg pain. It impacts the “SI joint” mentioned under # 7.

6. The SI joint has be painful since I was a young child. It's often in the back of my hips....but also affects my groin and thighs from time to time. The pain is typically worse with standing and walking and improved when lying down. The inflammation and arthritis in the SI joint also causes stiffness and pain in the pelvis. The only pain management I have found for this is manipulation by a chiropractor.

To complicate things, I'm told that arthritis has set in throughout my back. Apparently, for my neck, this has led to bone spurs and calcium deposits. Apparently these spurs have been developing for a few years now. This increases the nerve damage described above and is the main reason my neck based problems have worsened recently.
For my lower back, I have had arthritis in my SI for 10 years or more. More recently, I have started to get a lot of swelling in my lower back... increasing my lower back pain.

 
Old 08-06-2012, 11:18 AM   #5
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Re: Help reading my lumbar and cervical MRI

""The saving grace for me is that it never goes down both legs at the same time.""

I had to chuckle when I read that. Clearly, you are a person who's learned to deal with pain. OK, lemme see what I can do with the MRI's...

"Uncarthrosis" is a new word to me, but clearly it means "arthrosis of the uncinate process", and I'll go slightly out on a limb and say that's probably the same as what most radiologists call "uncovertabral joint osteophytes". That is, you have ridges on top of your cervical vertebrae that help stabilize the cervical spine, preventing unwanted slippage. With time - and a lot of use - these can become arthritic and lay on extra bone, which can intrude into the neuroforamina, which are the holes in the front/side of the spine through which pass the spinal nerves. If that excess bone grows too far, it can pinch those spinal nerves (radiculopathy), and cause a whole galaxy of symptoms that APPEAR to come from the areas serviced by those nerves (shoulders/arms) but in fact are happening entirely within the spine.

This is happening to you at C3-4 and C4-5. The radiologist does not sound any alarm at these levels, but he does say that the right C4-5 is worse than the left, which would make me wonder how much worse.

At C5-6 you have a small disk bulge which is indenting the spinal canal a little (the thecal sac surrounds the canal). The arthrosis is much worse at this level. Radiologists usually employ minimal/mild/moderate/severe to describe levels of severity, so you can see that anything that's "moderate to severe" is probably trouble. Your C6 nerves - which go down to the thumbs - are in jeopardy of impingement on both sides, more so on the left. You can look up C6 nerve to see everywhere it goes.

Same arthrosis problem at C6-7 (the C7 nerve ends up in the middle fingers), but a little worse. You also have bone spurs from above and/or below the disk growing backward into your spinal canal (perhaps accompanied by the C6-7 disk?). He says this creates mild "spinal canal compression" but does not say that the CORD (inside the canal, with a cushion of spinal fluid) is being affected (unless that's what "no mass effect" means).

As for surgical options.... if you were in the right city in the right country, you might get a laminoplasty with accompanying foramintomies done. That is, they'd decompress the spinal canal from behind, and at the same time try to trim back those arthritic uncinate processes. I suppose that most spinal surgeons, though, might recommend ADCF's (if they recommend surgery at all). That may be because most surgeons only know how to do ACDF's.

What's this waiting 12 months all about? Where are you?

BTW, I understand that you can get a standing MRI, if you think that really matters.

I may be able to blather a little about your lumbar, but I have to get back to my day job, for now. Please keep in mind that I'm an amateur expressing pretty-much-uneducated opinions.

Last edited by WebDozer; 08-06-2012 at 11:21 AM.

 
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Old 08-06-2012, 04:37 PM   #6
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Cool Re: Help reading my lumbar and cervical MRI

Thanks Webdozer.

Re: your questions "What's this waiting 12 months all about? Where are you?"

LOL. Welcome to Universal Health Care. I'm in Ottawa, On Canada. Everyone can get health care but you have to wait your turn.

Another problem is that Canadian Doctors go to the US...because they can make more $$$. So we always have a Dr shortage.

This means everything has a waiting list. My GP referred me to an Ortho surgeon at the end of January. The Ortho got back to him and advised that I needed to have an MRI done before he could meet me. My GP ordered it right away ...and I finally got the MRI in early July.

My GP has sent the MRI to to the Ortho and tells me not to expect an appointment until the end of the year or early in January. Then he says, the Ortho will want to get advice from a Neuro ....which mean another 6 months waiting for an appointment. So by this time next year, I might have an idea of options for surgery.

Alicia

 
Old 08-06-2012, 07:00 PM   #7
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Re: Help reading my lumbar and cervical MRI

Let me give you part of my history....

1) called up one of the best spinal surgeons in LA on Monday (without a referral)
2) got an appointment for Thursday
3) during appointment, doc decides he wants thoracic MRI, "let's see if we can fit you in downstairs this afternoon, are you free?"
4) make appointment for followup with surgeon the following Monday, then go downstairs to get MRI
5) see surgeon on Monday and schedule surgery for two weeks later

My out-of-pocket cost was $300, because the surgeon didn't take insurance.

A year ago, after a physiatrist ordered an MRI, I saw three surgeons a total of six times (I think) and scheduled three surgeries (the first two canceled), all within two weeks or so.

Sixteen years ago, when I had my ACDF, I saw my GP, saw a neurologist, got an MRI, saw a surgeon and had surgery.... all from Wednesday to the next Wednesday.

Enough bragging about our excellent-if-you-can-afford-it system. The big downside for you is the pain, of course, but also that spinal problems can become more intractable over time, that is, temporary nerve effects can become permanent nerve damage. Let's hope that doesn't happen to you, because you've already got more than your share of spinal trouble.

As for your lumbar, there's only one place where the radiologist will go so far as to say there might be a problem, which is with the left L5. This certainly could cause what's called "sciatica", especially if it happens in positions other than the supine position of an MRI.

Other than that, I just don't know. Lots of things that aren't "right", but that's true of most people of a certain age. Whether those anomalies might cause symptoms, especially when stressed by non-supine positions, I'm afraid I can't say. My GUESS is that surgeons will recommend PT, which is probably not what you want to hear.

Back to the cervical, my opinion is that you need to do something about that uncarthrosis at the two worst levels. Maybe foraminotomies would do the trick?

Please keep in mind that I'm just an amateur who wants to help but can't get past being an amateur. I wish I could offer you more. Let us know how things go, when they go.

 
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Old 08-06-2012, 07:18 PM   #8
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Re: Help reading my lumbar and cervical MRI

Hi Webdozer, your information is much appreciated!

Alicia

 
Old 08-07-2012, 09:25 AM   #9
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Re: Help reading my lumbar and cervical MRI

Quote:
Originally Posted by WebDozer View Post
Let me give you part of my history....

1) called up one of the best spinal surgeons in LA on Monday (without a referral)
2) got an appointment for Thursday
3) during appointment, doc decides he wants thoracic MRI, "let's see if we can fit you in downstairs this afternoon, are you free?"
4) make appointment for followup with surgeon the following Monday, then go downstairs to get MRI
5) see surgeon on Monday and schedule surgery for two weeks later

My out-of-pocket cost was $300, because the surgeon didn't take insurance.

A year ago, after a physiatrist ordered an MRI, I saw three surgeons a total of six times (I think) and scheduled three surgeries (the first two canceled), all within two weeks or so.

Sixteen years ago, when I had my ACDF, I saw my GP, saw a neurologist, got an MRI, saw a surgeon and had surgery.... all from Wednesday to the next Wednesday.

Enough bragging about our excellent-if-you-can-afford-it system. The big downside for you is the pain, of course, but also that spinal problems can become more intractable over time, that is, temporary nerve effects can become permanent nerve damage. Let's hope that doesn't happen to you, because you've already got more than your share of spinal trouble.

As for your lumbar, there's only one place where the radiologist will go so far as to say there might be a problem, which is with the left L5. This certainly could cause what's called "sciatica", especially if it happens in positions other than the supine position of an MRI.

Other than that, I just don't know. Lots of things that aren't "right", but that's true of most people of a certain age. Whether those anomalies might cause symptoms, especially when stressed by non-supine positions, I'm afraid I can't say. My GUESS is that surgeons will recommend PT, which is probably not what you want to hear.

Back to the cervical, my opinion is that you need to do something about that uncarthrosis at the two worst levels. Maybe foraminotomies would do the trick?

Please keep in mind that I'm just an amateur who wants to help but can't get past being an amateur. I wish I could offer you more. Let us know how things go, when they go.

 
Old 08-07-2012, 09:42 AM   #10
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Re: Help reading my lumbar and cervical MRI

Hi again,

I need a bit of clarity on one disc bulge. Regarding the manner in which the disc bulge at L4-L5 is described, it seems to suggest that bulge is worse than the two above it. Here's the quote:

"L4-L5: there is mild diffuse disc bulge with superimposed with mild broad based central protrusion, indenting the anterior thecal sac with associated posterior annular fissure."

He says the two disc bulges above L4-L5 cause mild stenosis. He does mention that the bilateral facet damage causes no stenosis at L4-L5- but doesn't indicate if the slightly worse bulge at L4-L5 causes stenosis. Note a 2003 MRI indicated i had moderate to severe stenosis at L4-L5.

 
Old 08-07-2012, 10:42 AM   #11
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Re: Help reading my lumbar and cervical MRI

If the disk is pushing into the subarticular recess, I don't see how this isn't stenosis. The radiologist seems to be drawing an awfully fine distinction when he says it isn't foraminal or canal stenosis.

Also, the wording is rather confusing, although that may be my fault and not his...

 
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Old 08-07-2012, 03:53 PM   #12
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Re: Help reading my lumbar and cervical MRI

Quote:
Originally Posted by WebDozer View Post
If the disk is pushing into the subarticular recess, I don't see how this isn't stenosis. The radiologist seems to be drawing an awfully fine distinction when he says it isn't foraminal or canal stenosis.

Also, the wording is rather confusing, although that may be my fault and not his...

 
Old 08-07-2012, 03:56 PM   #13
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Re: Help reading my lumbar and cervical MRI

I agree with you - the wording is confusing. I think you "nailed it" when you said: "If the disk is pushing into the subarticular recess, I don't see how this isn't stenosis." Thanks

 
Old 08-07-2012, 04:36 PM   #14
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Re: Help reading my lumbar and cervical MRI

This whole thing about the subarticular recess is interesting. If you do a search on it you'll find one article that's rather emphatic that too many surgeons and radiologists don't really distinguish it well from the foramina.

Since your radiologist is the first one I've seen using the term, I guess that I have to accept his definitions, which is to say that when he talks about a subarticular recess, he does not consider it part of the canal or the foramen.

This could be the whole difference with the earlier MRI, that is, the earlier one was done by a different radiologist.

It's also possible that you just got better. Problems like degenerated facets, osteophytes and hypertrophied ligaments are unlikely to improve, but bulging disks do sometimes decide to go back where they belong.

Last edited by WebDozer; 08-07-2012 at 04:37 PM.

 
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