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Old 10-23-2012, 03:24 PM   #1
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Newbie needs help understanding mri and hearing others experiences!

Cervical spine MRI
About 4 weeks ago I had a dentist appt. and while receiving novicaine shots, the dentist hit a nerve directly which sent a shock up the side of my face. This was intense and I ended up being very tense for the 2 1/2 hour appt... Ever since then I have had toothache like pain in my left shoulder and arm... (you know how it feels when you hit your elbow? that is how my arm feels all the time). I did get checked out to make sure it was nothing heart related and they said that it most likely is a pinched nerve... it is so annoying! I have been taking Gabopentin in evenings to sleep, and it has helped, but take only advil during the day.

I have since had a neck X-ray, and MRI. About 2 1/2 years ago I slipped getting in shower and about 4 mos later had tingling in my left shoulder off and on. Eventually it just went away. My doc did do an EMG study then and agsin last week which was normal both times. From the MRI results she now tells me that there is a surgery in my futu and has referred me to a neurosurgeon. This is all new to me and I am trying to understand it all. Can someone please give me their thoughts?

Findings of MRI were as follows:

Cervical spine shows straightening of the normal cervical lordosis. Marrow signal abnormality related to degenerative changes are present, most pronounced at C3-C4. Vertebral body heights are mildly decreased stature from C3 to C6 secondary to chronic changes. There is disc desiccation throughout the cervical spine with disc space narrowing most notably at C3-C4. The cervical cord is normal in size and signal.

C1-C2 no evidence of central canal stenosis or neuroforaminal stenosis.
C2-C3 no evidence of central canal stenosis or neuroforaminal stenosis.
C3-C4 posterior disc osteophyte complex without central canal stenosis. There is severe left and moderate to severe right bilateral neuroforaminal stenosis. Moderate central canal stenosis is present.
C4-C5 no evidence of central canal stenosis or neuroforaminal stenosis.
C5-C6 broad based posterior disc protrusion which abuts the ventral cord. There is moderate central canal stenosis. Bilateral moderate neuroforaminal stenosis is present.
C6-C7 no evidence of central canal stenosis or neuroforaminal stenosis.
C7-T1 no evidence of central canal stenosis or neuroforaminal stenosis.

Right thyroid nodule.

IMPRESSION:

1. Multilevel degenerative changes, as described above.
2. Worst level of neuroforaminal stenosis is C3-c4, where there is severe left and moderate to severe right neuroforaminal stenosis.
3. Worst level of central canal stenosis is at C5-C6, where stenosis is moderate.

 
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Old 10-24-2012, 05:47 AM   #2
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Re: Newbie needs help understanding mri and hearing others experiences!

The first thing is to take note of the adjectives, as radiologists use a fairly standard set: minimal, mild, moderate and severe. The definitions that I would put on them are:

minimal - there, but barely noticeable

mild - clearly noticeable, but unlikely to be problematic

moderate - borderline problematic, refer to symptoms

severe - DO something about this!

At the C3-4 level, you have bone overgrowths coming into the spinal canal from in front (disk osteophyte complex). It is unclear - from your transciption - what effect this has on the spinal canal, because the transciption says both that there's "no central canal stenosis" and that "Moderate central canal stenosis is present". My guess would be that the latter is what was meant. So the spinal CANAL is narrowed a little, but the radiologist does not say that the CORD is affected. Note that the cord is cushioned within the canal by cerebrospinal fluid, so you have some leeway for the canal to be narrowed but the cord to remain unaffected.

More important, at this level those osteophytes are growing into the foramina on both sides. The foramina are the openings in the front/side of the spine through which pass the C4 peripheral nerves after they leave the cord. Impingements of the C4 nerves could create symptoms that appear to come from your shoulder. They would not create symptoms that appear to come from the fingers (that would be C6, C7 and C8).

C5-6 seems to be the only level where a disk is out of place. It is pushing back into the canal far enough to touch the front of the cord. No flattening or indentation of the cord is mentioned, so the radiologist, at least, does not seem to think that this is currently problematic. Once again, the foramina on both sides are narrowed, this time by the disk. While the radiologist calls this narrowing "moderate", keep in mind that "moderate" is just one step below "severe", and radiology is often as much interpretation as observation. If the peripheral nerve at this level (C6) were affected, you might feel it in your upper arm (triceps), but the clearest signal would be symptoms in your thumbs.

If you develop symptoms in your legs, this may be an indication that the disk bulge at C5-6 has gotten bad enough to affect the cord at that level.

As far as surgery goes, the only thing I can see that would be called for is to clear out the left foramen at C3-4. Some doctors might want to do an ACDF, where they come in from in front, remove the C3-4 disk and fuse the C3 and C4 vertebrae, but if I were you I would look into less drastic/invasive alternatives. There is an operation called a foraminotomy, which comes in diagonally from behind and cuts away the bone growths that are narrowing the foramen. This is minimally invasive (I had a C5 foraminotomy and left the hospital that afternoon). I don't know, however, if the foraminotomy can access the disk-osteophyte complex to cut it back.

If you do go to see a surgeon, most likely he will just suggest you wait and see. If he recommends an ACDF, I would get both a second and a third opinion.

Last edited by WebDozer; 10-24-2012 at 05:51 AM.

 
Old 10-24-2012, 03:46 PM   #3
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Re: Newbie needs help understanding mri and hearing others experiences!

thanks webDozer for your insightful response. I will keep you posted!

 
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