10-04-2012, 06:08 AM
Join Date: Sep 2012
Need Help decided what to do and understanding results
Examination performed 14/08/2012 at 08:30
REQUISITION #: RA2011106158
MRI OF THE CERVICAL SPINE :
CLINICAL HISTORY: Follow-up myelomalacia in the cervical spine.
COMPARISON: MRI from December 23, 2008.
There is mild retrolisthesis of C4 on C5 and C5 on C6, mildly progressed when compared to previous, on the basis of degenerative changes. There is reversal of the normal lordosis in the upper cervical spine.
Some edematous changes are seen within the endplates subjacent to the C5-6 intervertebral. Edematous changes are also noted in the left C7 superior articular facet, pedicle, and lamina. The remainder of the bone marrow demonstrates no significant abnormalities.
Unremarkable craniocervical junction.
C2-3: Left facet arthrosis without sequelae.
C3-4: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the right. The central canal is borderline narrowed at this level. There is moderate right-sided neural foraminal stenosis.
C4-5: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the right. Mild ligamentum flavum hypertrophy is seen at this level. This results in mild central canal stenosis as well as moderate-to-severe right and moderate left neural foraminal stenosis.
C5-6: There is central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis. This has progressed compared to previous. There is mild ligamentum flavum hypertrophy at this level. These changes result in moderate-to-severe central canal stenosis, indentation of the thecal sac and flattening and deformity of the anterior spinal cord. No gross myelopathic changes are seen, however. There is moderate-to-severe bilateral neural foraminal stenosis.
C6-7: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the left. There is bilateral ligamentum flavum hypertrophy at this level. This results in mild left neural foraminal stenosis. No central canal stenosis.
C7-T1: There is diffuse disk bulge with a small central disk protrusion as well as ligamentum flavum hypertrophy. There is advanced left-sided facet arthrosis with associated edematous changes within the left pedicle and lamina and superior articular facet of C7. There is mild left neural foraminal stenosis. No central canal stenosis.
1. Interval significant decrease in size of the colloid cyst, currently measuring less than 2 mm in keeping with either spontaneous resolution or interval surgical intervention.
2. Multilevel degenerative changes in the cervical spine demonstrating progression compared to previous, mainly at the C5-6 level, where there is moderate-severe central canal stenosis with slight worsening of the retrolisthesis. No myelopathic changes are seen. New bone marrow edematous changes in the posterior elements of the left C7, presumably due to worsening of facet arthrosis.
10-04-2012, 09:00 PM
Join Date: Sep 2012
Re: Need Help decided what to do and understanding results
Originally Posted by WebDozer
Smokey - I will give you a detailed reply, but can you tell me what part(s) of that you don't understand? Also, what are you symptoms now, and what were they back in 2008 when the first MRI was done?
The 1st MRI was in 2006 when I had started with numbness down my left arm.
I wear a soft collar at night. The worst pain is in my shoulder. I have very limited ROM of my neck. I do not really understand the terminology in te report,
1 Surgeon wants to operate and do a fusion and another says wait until the my symtoms gets worse. I am going to my Neurologist next week , what should I be asking him.....
MRI OF THE CERVICAL SPINE:
There is straightening of the physiological lordosis with a partial kyphosis at C4-C5. There is a pseudolisthesis C2-C3, C3-C4, C4-C5, C5-C6, likely related to degenerative changes.
There are anterior and posterior osteophytes.
Mild irregular aspect of the different endplates more evident on the inferior C6.
No significant abnormalities on bone marrow signal of the cervical spine vertebral bodies noted.
Unremarkable craniocervical junction, C1-C2 and C2-C3.
C3-C4: There is a mild uncal disk arthrosis with posterior osteophytes causing borderline narrow spinal canal and mild right neural foraminal stenosis.
C4-C5: Moderate uncal disk arthrosis with anterior and posterior osteophytes causing mild spinal stenosis and moderate to severe right and moderate left neural foraminal stenosis. The cord appears deformed with a slight decreased anteroposterior diameter. No clear evidence of myelopathic changes associated.
C5-C6: Moderate uncal disk arthrosis with large anterior and posterior osteophytes causing moderate spinal canal stenosis. The cord appears deformed, decreased in anteroposterior diameter with slight hyperintense signal, left lateralized. This may represent myelopathic changes.
There is a severe left and moderate to severe right neural foraminal stenosis may cause impingement of the exiting nerve roots.
C6-C7: Mild to moderate uncal disk arthrosis with left posterolateral osteophyte causing mild left-sided spinal canal stenosis. No cord compression noted. There is a moderate to severe left neural foraminal stenosis may cause impingement of the exiting nerve root. There is a mild right neural foraminal stenosis.
C7-T1: Mild degenerative changes affecting mostly the facet joints causing mild left neural foraminal stenosis. The spinal canal and right neural foramina are within normal limits.
IMPRESSION: Multilevel degenerative changes more evident at C4-C5, C5-C6 and lesser degree C6-C7. Possible myelopathic changes at C5-C6. Multilevel neural foraminal stenosis as described.
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10-05-2012, 12:06 PM
Join Date: May 2011
Location: So Cal
Re: Need Help decided what to do and understanding results
Smokey - The 2012 MRI does not seem a whole lot worse than the 2008. I think that many surgeons would have operated back in 2008, actually, at least to do something about the apparent impingement of the left C6 nerve, which would have caused symptoms (tingling, numbness, weakness, pain) from the shoulder down to the thumb.
REVERSAL OF LORDOSIS - Lordosis just means a backward curve of the ascending spine. Some areas should be lordotic, and the neck is one. Reversal of lordosis in the neck is pretty common. It just means that the neck is not as curved back as it ought to be, the head is more likely to point down, and increasing pressure is put on the spinal column. It's the severity that's important, though, and your radiologist hasn't been much help there.
RETROLISTHESIS - One vertebrae being displaced BACKWARD compared to another. So your C4 is displaced backward over the C5, and the C5 is displaced backward over the C6.
LIGAMENTUM FLAVUM - the ligament that holds the lamina at each level to the lamina at adjacent levels. It runs down the BACK of the spinal canal, so if it is hypertrophied, it is squeezing the canal from BEHIND.
FACET - In the back/side of the spine, where the different levels meet. There is some limited freedom of movement here, one level upon another, so it's called a "joint". Osteoarthritis can cause hypertrophy over time, with osteophytes (bone spurs) growing off the facets and either pushing on the spinal canal from the SIDE, or pushing into the neural foramina.
NEURAL FORAMINA - These are openings in the front/side of the spinal structure, one on each side at each level. The spinal nerves leave the spinal cord, pass through the foramina, then head down to your shoulders and arms.
UNCARTHROSIS - Osteoarthritis of the uncinate process, which is a ridge that grows off the sides and back of the cervical vertebrae (the disks fit into it, and are stabilized by it). Osteophytes can grow off the uncinate processes and either into the spinal canal (from in FRONT) or into the neural foramina.
DISK OSTEOPHYTE COMPLEX - Multiple osteophytes (bone spurs) growing off the vertebrae where they interace with the disks. These are growing BACKWARD into either the spinal canal or the neural foramina. They may be associated with bulging disks.
Your problem levels are C5-6 (advanced), C4-5 (getting there) and C3-4 (starting).
I would expect worse problems in your right shoulder/arm (than in the left) because of the multi-level moderate-to-severe narrowing. While the left side could be bad at C5-6, it seems to have gotten better at C6-7, which I can't explain. BTW, the C7 nerve would show symptoms mostly in the middle fingers.
The radiologist would have been a lot more helpful if he'd included measurements of the growths and stenosis at various levels. I guess he's counting on the surgeons to view the images themselves and ignore his report, which I'm told is not uncommon.
As for surgeries, I'm sure the surgeon who wants to operate wants to take out the C5-6. He may well want to do the C4-5 while he's at it. If he took out both levels, your neck's range-of-motion MIGHT be reduced to 50% of normal (maybe as high as 70%), although from what you say it's so bad now that this might be an improvement. I would hope that the surgery can deal with the uncarthrosis and the disk osteophyte complexes. Something to ask. Another thing to ask is, if the surgeon only wants to do the C5-6, then what can be done about the foraminal narrowing at C4-5, which just MIGHT be the cause of many/most of your symptoms. Can they do a separate surgery (a "foraminotomy") from behind to clear out the foramina? (foraminotomies are minimally invasive, usually with brief and easy recoveries).
There's another surgery that some surgeons would suggest, which is the laminoplasty. This does not come in from the front, and does not remove disks and fuse vertebrae. Instead, it "decompresses" the spinal canal by cutting the lamina on one side, then swinging that lamina open and propping it with a titanium brace. It's not unusual to do three or four levels in one operation. The hypertrophied ligamentum flavum is thus pulled away from the spinal canal, and the cord is given more room to "escape" backward from the uncarthrosis and disc osteophytes encroaching from in front. Range of motion is preserved.
I've had all three operations mentioned - single-level fusion in 1996, left C5 foraminotomy in 2004, and C4,5,6 laminoplasty in 2011. Many docs do not know how to do laminoplasties (or don't know how to avoid neck muscle damage when doing them), and so will only suggest fusions.
Of course, I'm just a slightly educated amateur with a little too much personal experience, who's trying to give you a little better understanding of your situation, and the options for dealing with it.
Last edited by WebDozer; 10-05-2012 at 12:12 PM.
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