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KingFelix 08-24-2012 12:22 PM

MRI Analyses
 
I have had neck pain for over 20 years. I was in a car accident at age 18, suffered a skull fracture and concussion, received 18 stitches on my left side, 4" above my ear. I have had 2 MRI's on my neck, one in July, 2008 and one in August, 2012. My neck always hurts, always on the right side. I have had radiculopathy off and on, but have kept things more or less under control with PT, NSAIDS, home traction and such.

I had a lot of trouble with my right shoulder starting a year ago, was diagnosed with a partial rotator cuff tear, couldn't get in to see an ortho for 3 months. The PT said my right shoulder was noticeably smaller than my left and my biomechanics were completely out of whack. I started getting a specific headache, a shooting pain in the right eye socket a couple months ago. Two weeks ago I was holding a large, glass mug of hot tea in my right hand. The mug dropped in my lap, giving me a pretty good scalding, but fortunately not a serious burn. I have had the 'clumsy hand' going on for a while. I have a very good primary care doctor now, who ordered the MRI and is sending me off for electrical studies and to a neuro-surgeon. Previous electrical studies have been normal. My primary said I might need 'decompression'.

When I started having the shoulder trouble last year I described it as 'my right arm doesn't feel attached to my body'. Is this more likely from the further cervical degeneration, as opposed to an 8mm rotator cuff tear?

July, 2008

Straightening of the normal cervical lordosis. No evidence of compression deformity or listhesis. Brainstem and cervical cord demonstrate normal morphology and signal. However, there is mild indentation of the cord in the mid cervical spine from degenerative disc disease.

Brainstem-C3: Mild bilateral facet arthrosis. No protrusion or stenosis.
C3-C4: Mild bilateral arthrosis. No protrusion or stenosis.
C4-C5: Moderate posterior diffuse disc bulge-osteophyte complex with more focal protrusions in the right and left paracentral regions. Moderate bilateral uncovertabral hypertrophy. Moderate right foraminal stenosis. Canal diameter lower limits normal at 1 cm, but no definite central canal stenosis.
C5-C6 Moderate posterior disc bulge-osteophyte complex. Moderate bilateral uncovertebral hypertrophy, right greater than left. Moderate right and mild left foraminal stenosis.
C6-C7: Moderate disc space narrowing. Mild disc bulge-osteophyte complex. Mild bilateral uncovertebral hypertrophy. Mild to moderate bilateral foraminal stenoses. No central canal stenosis.
C7-T4: These levels appear normal

August, 2012

Findings: Further progression of reversal of normal cervical lordosis centered at C5. Vertebral body heights are normal. Type II bone marrow changes are present at C5 and C6. Normal relationships are seen of the structures at the craniocervical junction. There is no evidence for Chiari malformation.

C2-C3: no evidence for disc herniation, foraminal encroachment or canal stenosis.
C3-C4: no evidence for disc herniation, foraminal encroachment or canal stenosis.
C4-C5: there is a broad based posterior osteophytic ridge unchanged from prior examination. Moderate left facet arthropathy has progressed. There is moderate left formaminal encroachment, previously mild. There is a right-sided posterior lateral disc herniation that appears to impinge on the right C5 nerve root, this is slightly larger than observed on the prior study.
C5-C6: there is a broad based posterior osteophytic ridge impresses upon the thecal sac but does not compress the spinal cord. The AP dimension of the spinal canal is 8mm, previously 10mm. Bilateral uncovertabral joint which is also increased in size resulting in moderate to bilateral foraminal encroachment. A soft disc herniation is not identified.
C6-C7: there is a broad based posterior osteophyte which has increased in size from the prior study. The AP dimension of the spinal canal is 9mm, previously 11mm. Lateral uncovertabral changes result in severe bilateral foraminal encroachment, or 4 previously there was mild right and moderate left foraminal encroachment. A soft disc herniation is not identified.
C7-T1: there is no evidence for disc herniation, foraminal encroachment or canal stenosis.

WebDozer 08-24-2012 01:20 PM

Re: MRI Analyses
 
At C5-6, you typed "moderate to bilateral foraminal". Did the report say "moderate to SEVERE bilateral foraminal" ?

KingFelix 08-24-2012 01:27 PM

Re: MRI Analyses
 
[QUOTE=WebDozer;5044907]At C5-6, you typed "moderate to bilateral foraminal". Did the report say "moderate to SEVERE bilateral foraminal" ?[/QUOTE]

I typed exactly what is on the written report.

WebDozer 08-24-2012 01:45 PM

Re: MRI Analyses
 
OK, well that doesn't make sense. Sort of like describing something as "small to yellow". I think I will just assume that the word "severe" was dropped, because that's the ONLY word that could make that sentence make sense.

I'm a little confused by the statement in the first MRI that "there is mild indentation of the cord in the mid cervical spine", because he in no way backs that up when describing the individual levels.

Anyway... to my slightly (self-) educated eye, it certainly seems plausible that you're suffering from radiculopathy at three levels on the right side and one or possibly two on the left. I think I can sympathize with the feeling that your right arm isn't "connected", and my GUESS would be that it has more to do with the cervical spine than with the rotator cuff. As for your right arm being smaller, I have that with my right leg, the result of cord damage many years ago. If the nerve pathways to certain muscle fibers are interrupted, those muscle fibers will atrophy from lack of use.

There are so many things that need to be addressed that I'd have a hard time saying what the best surgery(ies) would be. Hard to even guess what the surgeon will want to do, but I'd bet he'll want to take out the C5-6 disk, at a minimum. Some surgeons would probably want to go C4-C7.

I don't know if removing the disks (ACDF's) would address the bone overgrowths in the facets and the uncovertebral joints, or even if they'd fix the osteophyte complexes. My guesses would be "no" to the facets, "maybe" to the uncovertebrals and "probably" to the osteophyte ridges. The surgeon, of course, will be able to tell you in a second.

I think you need surgery. Maybe even REALLY need surgery. Of course, my opinion counts for almost nothing, but be prepared for the surgeon to tell you something similar.

Let us know what he says, please....

KingFelix 08-24-2012 02:32 PM

Re: MRI Analyses
 
I was confused on the same items you mention in your first 2 paragraphs. The Type II Bone Marrow change was something I have never heard of, but near as I can tell means I have micro-fractures in the vertebra and when I say 'my neck always hurts', it really does.

Thanks for the input. I see the neurosurgeon on Wednesday. I was/am hoping to put off surgery for as long as possible.

WebDozer 08-24-2012 02:54 PM

Re: MRI Analyses
 
OK, but keep in mind that unattended nerve problems can go from fixable to permanent over time.

Good luck, and let us know what the surgeon says...

KingFelix 08-24-2012 03:12 PM

Re: MRI Analyses
 
I know, I was very fortunate I didn't sustain a serious burn from the tea.

KingFelix 08-25-2012 09:13 AM

Re: MRI Analyses
 
WebDozer-you seem to prefer neurosurgeons. Up here in Seattle the UW medical school has some impressive work going on within the ortho-spine department. I am wondering if an ortho with a cervical spine specialty might be better than a neurosurgeon, especially with regards to the heavy growth of osteophytes.

I have maintained very good range of motion and score well on the standard in-office neurological tests. The nerve conduction test is Monday, my third since 2004. The other 2 were completely normal. I also have a herniated disc at L3-L4, it protrudes to the left, but all the pain is in my right hip, so I seem to be wired a bit differently. I also had meningitis at age 26, it took a long time for me to recover. I suspect the meningitis made my central nervous system hypersensitive. I would not be surprised if the electrical study comes back as unremarkable. I received a lot of blank looks from various doc's and PT's when I told them it felt like my arm wasn't attached, given that my reflexes and overall strength appear within the normal range.

I am wondering if it wouldn't be better to do the least amount required now, remove the one disc, reduce the osteophytes, open the foraminal areas rather than multiple level fusion. My overall health is excellent and I have worked hard to maintain my strength and range of motion. Do you have any links to the research on adjacent disc deterioration in fusion surgeries? I am extremely uneasy about having a fusion.

WebDozer 08-25-2012 10:09 AM

Re: MRI Analyses
 
<< you seem to prefer neurosurgeons >>

I prefer spine specialists. Cervical specialists even better. I have no interest in whether they came from orthopedics or neurosurgery.

<< I received a lot of blank looks from various doc's and PT's when I told them it felt like my arm wasn't attached >>

Maybe because that's not a result of cervical spinal problems, but maybe also because the doc's and PT's DON'T HAVE nerve damage, so they can't fit they way you feel into any template they understand.

<< I am wondering if it wouldn't be better to do the least amount required now, remove the one disc, reduce the osteophytes, open the foraminal areas rather than multiple level fusion. >>

You're talking about multiple surgeries, at least two and maybe three. You could do an ACDF at C5-6, but then you'd have to come in from behind to get at the osteophytes at the other two levels. Since those osteophytes are at two non-adjacent levels, that might be two surgeries just for them... I don't know. I also don't know if uncovertebral osteophytes, or disk-osteophyte complexes, can even be accessed from behind.

Easy questions for the surgeons to answer.

<< Do you have any links to the research on adjacent disc deterioration in fusion surgeries? >>

This site doesn't like us to put links in our posts. Easy enough to find a number of things if you do a search on "adjacent disk disease". Opinions are all over the board. I guess you could boil it down by saying that fusions put adjacent levels under more pressure, but the actual necessity for follow-up operations is still fairly low.

KingFelix 08-25-2012 03:24 PM

Re: MRI Analyses
 
Thanks for the clarification on neuro v ortho. My apologies for
'getting the wrong end of the stick' as my British friends would say.
I appreciate your feedback and will let you know what the neurosurgeon
says. I am going to get an appointment at the UW spine center as well.
If I am looking at surgery/surgeries I think I should have it done there. Thanks
again, it is kind of you to be a sounding board for whoever shows up.
It makes things seem far less daunting.

KingFelix 08-29-2012 02:05 PM

Re: MRI Analyses
 
The Neurosurgeon wants to do a 3 level foraminotomy, C3-C4, C4-C5 and C5-C6. Electrical study shows mild carpal tunnel. He said a fusion wasn't necessary and wasn't concerned about the osteophytes. I am going to see a spine specialists at the UW in 3 weeks for a second opinion.

WebDozer 08-29-2012 02:29 PM

Re: MRI Analyses
 
Sounds good! The ACDF at C5-6 can wait. Hopefully you will never need it.

Did the surgeon specify if he wants to do both sides at all three levels?

I'm very interested to see how that turns out. How many incisions will be necessary and what the recovery will be like....

KingFelix 09-09-2012 08:32 PM

Re: MRI Analyses
 
The neurosurgeon was not specific. I did see a spine-rehabilitative doctor within the UW group last week. He noticed that my right trapezius is significantly atrophied. I had a partial right rotator cuff tear a year ago-it didn't require surgery, but I am still rehabbing it. The spine doctor thinks my shoulder is causing more pain/symptoms than the cervical DDD.
My PCP also sent me for an ultrasound for Thoracic Outlet Syndrome this past friday, which showed positive.
The chart records for my shoulder stated 'frozen shoulder', which puzzled both me and the spine doctor. My shoulder is still hypermobile-similar to 'dead arm', definitely not a frozen shoulder. I am getting another shoulder MRI, with arthrogram tuesday. The right trapezius wasting and occupital headache could be from nerve damage, apparently or TOS. Things are becoming more confusing. My appointment with the spine surgeon is in 10 days-hopefully he can make some sense of all the data.

nochange 09-10-2012 06:01 AM

Re: MRI Analyses
 
Look what happened to you. One car accident destroyed your whole life. They should have never invented those machines called cars and keep those wagons. At least, with wagons you can't have whiplash. On top of it they cannot cure chronic pain caused by car accident with all those soft tissue damage.

They say with BMW you cannot be injured in case you are in a car accident.
Not cheap, but perhaps worth the price.

WebDozer 09-10-2012 06:41 AM

Re: MRI Analyses
 
<< The neurosurgeon was not specific. >>

Not important, really. It's only your cervical spine....


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