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Old 11-02-2012, 03:52 PM   #1
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Degenerative Disc Disease with Cervical Radiculapathy

Hi, I am new to this board. I am 55 yr old female. I have had Degenerative Disc Disease for several yrs now and was diagnosed w/ Radiculopathy in both arms about 5 yrs ago. I have been on Flexeril and Lyrica to help with the pain. I was told then I could have surgery if I chose to but I did not. My present Primary Care Dr. recently ordered a new MRI on my neck. He only told me that I HAD to go see a neurosurgeon so he has sent a referral to Shreveport LSU Hospital. Well, this could take several months to get an appt there. In the mean time, Can someone please help me understand what this report is saying? I am not asking for a diagnosis, but just help in understanding in english what the report says. It is as follows...

FINDINGS: There is loss of the normal cervical lordosis. Note is made of congenital narrowing of the cervical spine. Vertebral body height and alignment are maintained throughout the cervical spine. No abnormal signal within the spinal cord. The craniocervical junction is unremarkable.
Multilevel intervertebral disc dessication. Intervertebral disc height is maintained throughout the cervical spine. No abnormal marrow signal. The paravertebral soft tissues are unremarkable.

C2-C3 Unremarkable

C3-C4 Intervertebral disc bulge. The central canal is narrowed to 8 mm. No neural foraminal narrowing.

C4-C5 Right paracentral intervertebral disc protrusion which narrows the right lateral recess and contacts the right side of the cord. The central canal is narrowed to 8 mm. There is mild right neural foraminal narrowing. No left neural foraminal narrowing.

C5-C6 Diffuse intervertebral disc bulge with superimposed left paracentral disc protrusion. There is complete effacement of the ventral subarachnoid space. The left paracentral disc protrusion narrows the left lateral recess and contacts the left side of the cord. The central canal is narrowed tp 7 mm. Moderate bilateral neural foraminal narrowing.

C6-C7 Diffuse intervertebral disc bulge with right lateral disc protrusion. Complete effacement of the ventral subarachnoid space and contact of the central cord. The central canal is narrowed to 6 mm. Severe right and mild left neural foraminal narrowing.

C7-T1 Diffuse intervertebral disc bulge with superimposed right lateral disc protrusion. Complete effacement of the ventral subarachnoid space. The central canal is narrowed to 7 mm. No neural foraminal narrowing.

IMPRESSION: Congenital narrowing of the cervical spinal canal with multilevel intervertebral disc bulges and protrusions. At C4-C5, right paracentral disc protrusion contacts the right side of the cord. At C5-C6, left paracentral disc protrusion contacts the central aspect of the cord. At C7-T1, diffuseintervertebral disc bulge narrows the spinal canal to 7 mm.

I would be so appreciative for the help. Thanks in advance.

 
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Old 11-19-2012, 07:10 PM   #2
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Re: Degenerative Disc Disease with Cervical Radiculapathy

ReeseCup - For one thing, you should not be making an appointment with a neurosurgeon. You should be making appointments with THREE neurosurgeons. I don't have time to go over everything in your MRI right now (remind me later and hopefully I can do better), but let me stress the most important part, which is that you have CONGENITAL NARROWING OF THE CANAL. I do too, so I know something about all this. The long and short is that this means it takes a lot less in the way of bone overgrowth or bulging disks for you to have a problem, because you have much less "room for error".

It also means that you're VERY likely to get wrong or inappropriate opinions from surgeons, because their standard surgeries don't deal with the central problem.

While you are waiting to see those THREE (I'm NOT kidding) surgeons, you might want to read up on the surgery called a "laminoplasty", which addresses the congenital narrowing problem.

Last edited by WebDozer; 11-19-2012 at 07:11 PM.

 
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Old 11-22-2012, 12:17 AM   #3
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Re: Degenerative Disc Disease with Cervical Radiculapathy

Thanx for your reply Webdozer! I will certainly be studying up on that!

 
Old 11-22-2012, 10:01 AM   #4
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Re: Degenerative Disc Disease with Cervical Radiculapathy

OK, back again....

If I didn't stress it enough before, this is the operative sentence in your report:

>>> Note is made of congenital narrowing of the cervical spine. <<<

Let me explain one level, and you can extrapolate to the others, OK?

<< C6-C7 Diffuse intervertebral disc bulge with right lateral disc protrusion. >>

The disk between the C6 and C7 vertebrae is bulging backward, more so on the right side. He doesn't say HOW BIG the bulge is, though, which is a CRITICAL piece of information.

<< Complete effacement of the ventral subarachnoid space >>

"Ventral" means "front" in this context. The "subarachnoid space" is the part of the spinal canal between the outer membrane (theca) and the spinal cord. This is filled with spinal fluid and should surround the cord. In your case, the bulging disk has "effaced" (pushed away) that space, so that the MRI shows no space for spinal fluid between the outer membrane and the cord. Not in front, that is.

<< and contact of the central cord >>

Kind of goes without saying that if the space in front of the cord is gone, then the cord has been "contacted".

<< The central canal is narrowed to 6 mm >>

That's pretty darn narrow. OK, I was down to 5mm (and I'm a big male type, in spite of the profile that HB has fit me with), but still, 6mm is cause for concern. I've read that cord compression that occurs over many years may have fewer symptoms than if it occurs quickly, so your 6mm may not be as bad as someone else's 7-8, but I don't think you'd be entirely non-symptomatic, and these symptoms could be a wide range of sensory, motor and functional effects anywhere downstream of the C6-7 level.

<< Severe right and mild left neural foraminal narrowing. >>

To be expected, given the above. This disk bulge is lopsided on the right and is pushing into the right foramen, which is the opening in the spinal cage through which passes the C6 nerve after it leaves the cord and eventually ends up in your thumb. Since the "root" of the nerve is being pinched, it's called "radiculopathy" ("problem with the root").

OK, so where does the congenital stenosis fit in? Because the radiologist does not say HOW BIG THE DISK BULGES ARE, we are left with the possibility - if not probability - that these bulges would not be large enough to be a problem in someone with a normal-sized canal. Because your canal is too small, relatively small bulges can have relatively large impacts.

This is important when determining treatment, or surgery. Surgically, the two main approaches to bulging disks are to either remove the disks, or INCREASE THE SIZE OF THE CANAL, through a decompression surgery such as a laminoplasty. The laminoplasty has the advantage of addressing multiple levels in one surgery without loss of rotational range-of-motion, but the disadvantage that the bulging disks are still bulging.

Last edited by WebDozer; 11-22-2012 at 10:14 AM.

 
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Old 11-22-2012, 11:25 PM   #5
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Re: Degenerative Disc Disease with Cervical Radiculapathy

Thanks for the detailed reply WebDozer. I think I am getting a better understanding now of what is going on in my neck. My next question would be "What about the problem of osteoporosis of the spine?" I don't think this is sounding very good because cutting into bone (the lamina) that is in osteo might be a problem. I just had a bone density done two weeks ago showing osteoporosis in my spine and osteopenia in my hips. Could this possibly interfere with any surgical help for me? I am not looking forward to a surgery but I definitely don't want to chance permanent nerve damage either.

Also I do not have the option for three opinions because I am on disability and cannot afford that. The closest Neurosurgeon for me is in Shreveport LSU. I live in South Louisiana. So even if I can have the option of surgery, once I go home I will be nearly 4 hrs away from my Dr. A definite hardship but one I will manage if I have to.

Thank you so much for helping me to understand all this a little better. I really do appreciate it.

 
Old 11-23-2012, 06:33 AM   #6
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Re: Degenerative Disc Disease with Cervical Radiculapathy

I really have no idea how much effect osteoporosis would have on surgical alternatives. Can't see how it helps, though....

 
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