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Old 02-24-2013, 09:17 AM   #1
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Red face MRI results regarding neck... CSF obliteration?

Hello everyone. I have been visiting these boards for a few years now. As back issues come and go. I have had lower back pain, thrown it out a few times, but it always manages to fix itself over time.

For the last year I have been dealing with neck and shoulder pain that has not gone away. Pain, crackling, major discomfort in neck, goes down into deep pain in both shoulders. Left arm weaker, tingly in fingers, and odd feelings in back of forearm by elbow. The pain has sometimes gone up left side of neck into ear.

I have seen a chiropractor which made it much worse, several GP and orthopedic visits and got muscle relaxes and pain meds. Last week I finally put in for extended sick leave as pain was interfering with my job as a high school teacher. MY Primary finally got me to get an MRI (I had been reluctant due to high cost) and after he got the results is referring me to a neurosurgeon ASAP. Here is the report. Any comments, insights, or interpretations will be much appreciated. Thanks so much in advance!

C2-3 no significant findings

C3-4 shallow left foraminal disc protusion with mild encroachment on the left C4 nerve root

C4-5 no significant findings. Minimal left foraminal

C5-6 broad based disc protusion and osteophytic ridging and uncinate spurring with mass effect on the ventral thecal sac and near obliteration of the anterior CSF space. There is also moderate foraminal stenosis bilaterally and both C6 nerve roots could be affected.

C6-7 small focal central disc protusion with focal impression on the ventral thecal sac.

C7-T1 no significant findings


Any help? I am a 44 year old female. I was in a few minor car accidents in my youth but nothing recent.

 
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Old 02-24-2013, 09:48 AM   #2
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Re: MRI results regarding neck...CSF obliteration?

Just based on the radiologist's report, I'm a little surprised at the "ASAP" recommendation to a surgeon. Lets look at the worst level...

<< C5-6 broad based disc protusion and osteophytic ridging and uncinate spurring >>

OK, so you have a bulging disk between your C5 and C6 vertebrae. The vertebrae also have bone overgrowth (call it osteophytes or call it bone spurs), probably above and below the bulging disk. No indication of the SIZE of the bulge is given.

<< with mass effect on the ventral thecal sac >>

The thecal sac is the membrane that surrounds the spinal canal and holds in the cerebro-spinal fluid (CSF). The disk/osteophyte complex is pushing back into it.

<< and near obliteration of the anterior CSF space >>

Inside the thecal sac (that is, in your spinal canal), you have CSF surrounding your spinal cord. Among other things, this space serves as a buffer that keeps intrusions into the canal (bulging disks, bone spurs, etc) from impacting the spinal cord itself. The radiologist does NOT say that your cord is affected, and he certainly would/should if he thought so. In fact, it says that the CSF is NEARLY "obliterated" (usually, the less dramatic word "effaced" is used). If some CSF is still showing, that IMPLIES that the cord is not yet affected.

<< There is also moderate foraminal stenosis bilaterally and both C6 nerve roots could be affected >>

Remember that you have a BROAD-BASED disk bulge? This means that it's not lopsided (as many bulges are), and means that it could be affecting BOTH foramina, which are the openings on the side of the spine through which the spinal nerves pass. The radiologist does not use the adjective "'severe" to describe the effect on your C6 nerves ("moderate" is the next step down), but the admission that the nerve roots could be affected tells us that another radiologist MIGHT have rated the foraminal problem as "severe". The FORAMINAL problems (not the cord/sac problem) could be causing neck pain and various shoulder/arm symptoms, running down into your thumbs.

I don't know if surgery is called for. I do think you need a second opinion on this MRI. You can certainly get that from a surgeon, who should be able to read the MRI as well as a radiologist, but if you go to a neurologist - or perhaps better, another radiologist - you'll be getting an opinion unbiased by the desire to make money by doing a surgery.

 
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Old 02-24-2013, 10:05 AM   #3
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Re: MRI results regarding neck...CSF obliteration?

..........

Last edited by WebDozer; 02-24-2013 at 10:07 AM.

 
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Old 02-24-2013, 10:17 AM   #4
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Re: MRI results regarding neck...CSF obliteration?

My primary physician (a PA not MD) actually looked into my eyes, shook his head and referring to the MRI said, "This is very impressive. Very bad." And of course scared me quite a bit. While explaining it to me he said that the neurosurgeon might go straight to surgery based on length of symptoms and severity of pain.

Your remarks have put this into perspective for me. I have been googling compulsively and I've read everything from, "all damage can be reversed by changing posture and moderate exercise," to, "surgery will prevent certain permanent nerve damage."

One thing I have learned from these boards though, is second opinion, second opinion, second opinion.

Now, WebDozer, you seem to indicate that there is room for interpretation in the way the radiologist reads the report? I guess I was under the assumption that this was a kind of a standardized process- that every radiologist uses the same methods and tools for assessment, so therefore the readings will be consistent no matter who reads them.

So, perhaps my pain can be explained by the MRI report but it can be resolved with conservative exercise and rest?

Also, I have taken oral Prednizone once for back problems and had a terrible reaction to it with only one pill. Would an epidural produce the same effects?

Thanks so much for your assistance!

 
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Old 02-24-2013, 10:18 AM   #5
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Re: MRI results regarding neck...CSF obliteration?

Double post- sorry (delete post entirely option?)

Last edited by MJude68; 02-24-2013 at 10:23 AM. Reason: double post

 
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Old 02-24-2013, 10:31 AM   #6
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Re: MRI results regarding neck...CSF obliteration?

<< So, perhaps my pain can be explained by the MRI report but it can be resolved with conservative exercise and rest? >>

Or, conversely, the pain is NOT explained by the MRI report, but MIGHT be explained by a different radiologist looking at the same images, who might give a stronger indication of the need for surgery. Another way of putting it is that your MRI might call for surgery, but only when your symptoms are also taken into consideration.

Anyway, I strongly urge you to get TWO more opinions. Perhaps one surgeon and one non-surgeon. IN ADDITION, consider a second opinion from a radiologist. You can find radiologists online who do that sort of thing.

<< Also, I have taken oral Prednizone once for back problems and had a terrible reaction to it with only one pill. Would an epidural produce the same effects? >>

No idea... but I think you may be barking up the wrong tree in thinking that drugs will help much. My guess is that your problem is structural, and must be treated accordingly...

 
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Old 02-24-2013, 10:45 AM   #7
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Re: MRI results regarding neck...CSF obliteration?

I will definitely take your advice and get another MRI opinion. When I see the neurosurgeon, will he his own reading of the MRI?

Regarding the epidural, isn't that used to reduce pain so everything has time to heal on its own?

What do you mean by "structural" problems?

Also, if I use an online radiologist, do I get a copy of the MRI on a cd and mail it to him?

MUCH MUCH THANKS
My overall impression is that you suspect my MRI reading doesn't quite mesh due to some incongruous language in his report?

 
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Old 02-24-2013, 11:19 AM   #8
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Re: MRI results regarding neck...CSF obliteration?

..........

Last edited by WebDozer; 02-24-2013 at 11:25 AM.

 
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Old 02-24-2013, 11:20 AM   #9
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Re: MRI results regarding neck...CSF obliteration?

<< When I see the neurosurgeon, will he his own reading of the MRI? >>

He should. I have had two neurosurgeons tell me they don't even look at radiologists' reports. After all, they HAVE to be able to read the images better than a radiologist, as they have to perform surgery based on their reading. The radiologist spends most of his time looking for cancer.

<< Regarding the epidural, isn't that used to reduce pain so everything has time to heal on its own? >>

I'm not sure how osteophytes can "heal on their own". Maybe they can, but I don't see how...

<< What do you mean by "structural" problems? >>

Bone, as opposed to, say, chemical....

<< Also, if I use an online radiologist, do I get a copy of the MRI on a cd and mail it to him? >>

Sure, or get the imaging center to send it to him. You might want to get a couple of copies yourself, though, for second/third opinions.

<< My overall impression is that you suspect my MRI reading doesn't quite mesh due to some incongruous language in his report? >>

I don't see anything incongruous within the report, or even, necessarily, in the context of your symptoms. What's incongruous is your PA's alarm.

Last edited by WebDozer; 02-24-2013 at 11:23 AM.

 
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Old 02-24-2013, 11:46 AM   #10
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Re: MRI results regarding neck...CSF obliteration?

LOL and thanks for your help!

 
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Old 02-26-2013, 10:34 AM   #11
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Re: MRI results regarding neck...CSF obliteration?

Greetings everyone. Well, I saw the neurosurgeon today and I'm going to have ACDF surgery on March 11 to fuse C5-7. He was very confident that this will eliminate all pain and that it is a highly successful surgery. He gave me a 2-6 week recovery time. I have two questions. For those of you who have had the surgery, what was your recovery time? Also, when we're you able to drive? Second question is, he said some bone would be put in a little basket in the disc space to provide the fusion. Where does this bone come from and is this normal?

Thanks for everything. This board has been an amazing resource for me!

 
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