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Old 09-20-2012, 10:30 AM   #1
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Help with MRI please

Ok, I have gotten my pre surgery MRI report and need some opinions please...

Based on axial images, there does appear to be a significant spinal stenosis with flattening of the cervical cord at c4-5, c5-6 and even moderate stenosis at c6-7. There is flattening of the cord on all of these levels. No definitive focal disc herniation is seen.

I am confused why there is "flattening of the cervical cord" but no disc herniation?? is this possible?

My surgery was a fusion at c6-7 July 2011 and over the last few months the pain is unbearable I have new symptoms as well as horrible headaches. I am set to go to pain management in 3 weeks for these ongoing issues, but I am afraid there are more issues than just chronic pain from post fusion. Any opinions or advice would be GREATLY appreciated!

 
Old 09-20-2012, 11:08 AM   #2
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Re: Help with MRI please

This is the MRI from before the surgery? If so, I wonder why you got C6-7 fused, instead of the higher levels. I suppose the language used by the radiologist may be a bit non-standard, in that he means stenosis OF THE CORD, and he considers "stenosis" (narrowing) to be worse than "flattening".

A disk herniation is when the tough outer covering (annulus) of the disk breaks, and the soft inner material (nucleus) spills out. Most disk problems are not herniations, but rather "bulges", where the disk bulges out but does not break.

You can have a bulging disk, osteophytes (bone spurs) growing off the adjacent vertebrae, or a combination of the two. You may also have a smaller-than-normal spinal canal, so that anything bulging backward into it is more likely to affect the spinal cord because there's less "leeway" in the canal.

I suppose it was the original surgeon who sent you to pm? If so, I'd strongly advise getting another opinion, from a surgeon who is not connected to the first guy. I don't think you should have chronic pain from a one-level fusion over a year later.

 
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Old 09-21-2012, 05:44 AM   #3
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Re: Help with MRI please

Yes, it was from the surgeon. He said he was fixing the level I had "symptoms" from and wasnt going to touch the other levels since I wasnt effected by them yet.

My good friend is a neuro nurse and she is suggesting the same as you, get a new MRI and get a second opinion as I should not be in chronic pain if the surgery was done correctly. She said I dont want to "mask the pain" when I could have new issues that need addressed.

I am so beyond frustrated at this point, I am even noticing a difference in my mood and attitude due to the pain, just miserable

 
Old 09-21-2012, 05:50 AM   #4
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Re: Help with MRI please

Yes, it was from the surgeon. He said he was fixing the level I had "symptoms" from and wasnt going to touch the other levels since I wasnt effected by them yet. I dont understand how I seemed better for months, not 100% but better, then the symptoms came back and then some a few months back with new symptoms as well. I am hearing that once you are fused your body changes a little and this can effect the levels above and below?

My good friend is a neuro nurse and she is suggesting the same as you, get a new MRI and get a second opinion as I should not be in chronic pain if the surgery was done correctly. She said I dont want to "mask the pain" when I could have new issues that need addressed.

I am so beyond frustrated at this point, I am even noticing a difference in my mood and attitude due to the pain, just miserable

 
Old 09-21-2012, 10:01 AM   #5
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Re: Help with MRI please

Here are more definitions of the terms.....

Focal herniation is a herniated disc less than 90° of the disc circumference.

Broadbased herniation is a herniated disc in between 90°-180° of the disc circumference.

Bulging Disc is the presence of disc tissue 'circumferentially' (180°-360°) beyond the edges of the ring apophyses and is not considered a form of herniation.



From what you write...there is maybe more to the actual radiologists report with the actual MRI as you only give a paragraph or so. Usually there is explanation of every single level and then the "findings" at the end. If this came from your surgeon...then it seems it's only a partial reading of the MRI.

If you had flattening of the cord...it means you have herniations that are pushing into the spinal cord.

Are you on any nerve pain medication? How about a muscle relaxer? These can be very helpful with specific type of pain.

Having pain now does not mean that the surgery was done incorrectly. People can have extreme pain from a tiny bone spur...or as WD mentioned...just a bulging disc if it is pushing on a nerve.

The good news is that 85% of issues can be resolved non surgically.

The hard part is that people who have a lot of problems with their spine/discs....have to work every day at exercise, proper stretching, not smoking (this causes disc dehydration and further problems), and then getting possible injections or use of medication to handle the pain.

I've had 3, two-level, cervical fusions over the last 11 years with the last one being anterior and posterior approach.

I still have 3 severe herniations...two in the lumbar area and one in lower cervical/upper thoracic. As well as severe stenosis, and other issues. My Neuro and I are doing everything we can to avoid anymore surgery.

You can certainly get another MRI to see what is going on....but I'm trying to say that even with findings, you can hopefully work with your Neurosurgeon and possibly a Pain Management Dr. to do things to prevent another surgery.

Keep us posted...

 
Old 09-21-2012, 12:52 PM   #6
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Re: Help with MRI please

thanks so much, that was really helpful! I thought the report looked short also compared to what others post on here. That is all they gave me at the surgeons office when I asked for a copy.

I am not on any meds right now, havent seen the dr since 3 months post op, I just cant take it anymore,I have let the pain go on too long and I am miserable I tried muscle relaxers but they made me hyper instead of calm and relaxing my muscles so I am not crazy about them. Other than the smallest dose of percocet from my last apt, I havent tried anything else. Pain dr apt coming up in a few weeks, hopefully he can help! THanks again

 
Old 09-21-2012, 02:45 PM   #7
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Re: Help with MRI please

Just in case you haven't tried them all...There is Flexeril, Robaxin, Skelaxin, Baclofen, Soma, or Zanaflex that are all muscle relaxers.

So....maybe there is one that could possibly work for you as I definitely use mine a few times a week.

I used to be on Cymbalta for my nerve pain but was lucky the last surgery took care of most of it. The other nerve pain meds are Lyrica and Neurontin.

And then as you mentioned...there are opiates but it's always best to start on the lowest dosage and weakest one and then move from there if by chance this turns into a chronic issue that needs to be treated.

I will pray that you can get some answers and then if you need to find a Pain Mgmt. Dr. that you can set up with a good comprehensive program to help that includes all modalities.

At this point for me I use the medication but that is only a tiny part of my treatment. I do daily exercise, yoga/stretching, aqua therapy, injections, massage, acupuncture, TENS unit, steroid treatments when needed, eat well to maintain a healthy weight, counseling to deal with chronic pain, etc.

Just to name some things that provide an overall way to combat the chronic pain.

I look forward to your updates..

 
Old 10-12-2012, 01:00 PM   #8
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Re: Help with MRI please

Ok, first pain management apt was yesterday and I am not sure how I feel about the outcome. Like you said, I spent a great deal of time doing paperwork and then going over more paperwork with the nurse and finally the doc came in...

he was very nice, good bedside manners, besides the fact that he excused himself to take a call form his wife lol understandable though. Anyway, we went over my history and then he started pushing by my clavicle bone on each side....OUCH! he said "thats one of your problems" but it felt just like he hit a pressure point to me and nothing more? he said it was "Thorasic Outlet Syndrome".

Then he pushed directly on the back of my neck up and down and...OUCH again that is what hurt the most, actually brought tears to my eyes. Felt really tender and sore, like he ws pushing on a fresh bruise or something.

He wrapped up the appointment by saying he wants to see me back next week for a session with his chiropractor and then a week after that for injections. I am REALLY really nervous about the injections in my neck. He said there certainly are risks doing injections to the cervical spine and i would love some opionions!

 
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chronic pain, neck, pain management, pain medications



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