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Old 11-08-2013, 07:08 AM   #1
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neural foraminal narrowing, MRI help please

Please help me understand my MRI results. Neck pain for years, suddenly got very bad 6 months ago. I am an active 61 year old woman, have worked as a checker almost 20 years in very busy supermarket. Lots of repetitive lifting and scanning, the constant lifting hurts, I can feel the stress on my neck and am wondering if continueing this is just aggravating the problem or possibly making it worse. Along with the significant cervical pain I am also experiencing parasthesia in both hands with burning also in right hand. This has been for at least 5 years. No arm pain so don't know if this could be radicular. Left toes also have pins and needles. My MRI follows
minimal grade 1 spondylolisthesis of C2on C3 and C7 on T1
moderate to severe disk space narrowing from C3-C7, mild at C7-T1 and C2-C3
multilevel DDD and spondylosis. Mild to mod. facet arthropathy also noted.
At C6-7 spondylosis and disk bulging causing cord indentation and bilateral neural foraminal narrowing rt. greater than lft.
Visualized sp. cord normal in caliber and signal
Impression-
straightening of normal cervical lordosis. DDD causing cord indentation at C34. C45, C56 and C67. Neural foraminal narrowing which is most sig. at C45, C56 and C67. Facet osteoarthritis on the left at C23 with surrounding reactive bone marrow edema.
I am wondering what is difference between cord indentation and cord compression. I see compression often on boards so maybe indentation is not so bad. Is this a normal MRI for a 61 year old? What about the parasthesia and burning hands? I would love to hear from Webdozer and anyone else who could shed light on this. Thank you so much for reading this.

 
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Old 11-08-2013, 12:31 PM   #2
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Re: neural foraminal narrowing,MRI help please

This is not a normal MRI, but these problems are very common and increase with age. You have degenerative disc disease and arthritic changes with a bulging disc causing pressure on the nerve roots (foraminal narrowing), right worse than left. C3-C7 are affected mostly with cord compression, same as indentation, throughout those levels. The facet joints (off to the sides) are arthritic as well. The hand symptoms may be coming fro the neck or could be separate. With your type of work, carpal tunnel syndrome might be causing the hand symptoms. There is minimal slippage at C2-3 and C7-T1. You will likely need to see a neurosurgeon for long term relief, but Naproxen (OTC) may give you some relief. I think your work is probably aggravating this. Perhaps you could switch to a less physically demanding position within the same company. I would get the hands checked out too, as carpal tunnel can be treated conservatively in most cases, if that is what it is.

 
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Old 11-08-2013, 03:19 PM   #3
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Re: neural foraminal narrowing, MRI help please

Thank you Ladybug,
You mention my job could be aggravating my problem. I wonder if almost 20 years contributed to it. I try to be as active as I can but neck pain has been relentless. This has become a workmans comp issue . When my PCP ordered, then read the Mri, he immediately referred me to a Neuro. When nuero secretary called and asked pertinent questions re- setting up appt., she said "Stop right there, this sounds work related, we won't see you. You will thank me for this later" Yikes,so had to file workmans comp which did not make my boss happy, nor me happy. Since, have seen a spine specialist who ordered an injection, but alas the company denied my claim before that could happen. Got an attorney because I WANT that shot. It could help me finish out 4 more years working full time as is my plan for the future to work until I'm 65. I am not a complainer nor am I a malingerer. So far flexaril, ibuprophin and ice are helping me. I see a QME tomorrow and am VERY nervous. I know he will probably say there is no causation from work and that this is just typical for a 61 year old.
You say this is not a normal MRI, how bad is it? Will I be looking at surgery down the road, or should I just plan on conservative treatment,curb my activities and look for different position at work. I HATE that this has become a work issue. But honestly , the pain I have while working worries me. Thanks again for your input.

 
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Old 11-09-2013, 01:19 AM   #4
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Re: neural foraminal narrowing, MRI help please

I'm sorry you are having the complications of workmen's comp in addition to the physical problems. Honestly, I think with such widespread neck issues, some surgery is in your future. The injections sometimes work for awhile, but typically last weeks to months, not years. This is a progressive disorder that tends to worsen with time, age and continued trauma. Treatment could get very expensive, so as much as workmen's comp can be a pain, it can save you lots in the long run in medical expenses. I hope you get decent relief from the injections. They may buy you some time. In the meantime, I would explore other duties that don't involve so much neck motion and lifting.

 
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Old 11-09-2013, 04:53 AM   #5
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Re: neural foraminal narrowing, MRI help please

Thanks again Ladybug, the health boards are wonderful. I have been reading alot and educating myself. There are so many out there who need your help, what a blessing for those of us who are confused.

 
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Old 11-11-2013, 05:02 AM   #6
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Re: neural foraminal narrowing, MRI help please

Chris... there is something VERY IMPORTANT that you have to understand about your condition, and that is whether your multi-level compression is due to LARGE intrusions into your canal, or whether your canal started out too narrow and relatively small intrusions are causing the indentation.

There's a not-terribly-uncommoncondition called hereditary (or developmental) spinal stenosis whereby your pedicle bones are too short and the AP (front-to-back) space of the canal is narrower than it ought to be. This causes no trouble until you start to have intrusions into the canal, at which point you don't have the extra space to provide some leeway.

If you have large intrusions into a normal canal, then you might be looking at a multi-level (4?) ACDF. However, if you have smaller intrusions into a smaller-than-normal canal, then the option might be for a posterior decompressive surgery (laminoplasty) to open up the canal space.

You REALLY need to get this straight. You also REALLY need multiple opinions, especially of the first surgeon you see says you need ACDF's and won't consider laminoplasty.

 
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Old 11-11-2013, 07:50 AM   #7
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Re: neural foraminal narrowing, MRI help please

Thanks Webdozer,I see nothing on MRI report that refers to my having hereditary stenosis, wouldn't this mentioned on report? As far as intrusions, my spine specialist recorded on his notes re- MRI. a left sided osteophyte and disk protrusion, contained @ C56, C5 sits behindC6, also on another Dr. visit note, same Dr., he says, disk herniation central and to the right @ C56.
I was looking at past x-ray findings and found
in 2007
anterior osteophytes seen @ C45,C56 and C67.
In 2010,
moderate degenerative findings C34 through C67 in the form of thinning intervertebral disks and osteophytic spurring of vertebral bodies.
there is fairly severe impingement on neural foramina bilaterally at C67 secondary to these osteophytes.
As far as to whether these are large or small, no size is mentioned.
This has become, to my regret, a workmans comp situation, and am not sure whether my job has been a contribution, I guess I'll find out soon enough, very intimidating. I wish someone could advise me as to whether my condition might progress if I stay working full time. So far ibuprophin gets me through a work day, barely. I refuse to take anything stronger as far as pain. Flexaril at night helps I think. At least it helps me fall asleep.Burning hands wake me up in early AM but this could be a different Dx. since I have no symptoms in arms.
You and LadybuD have been very helpful.

 
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Old 11-11-2013, 08:29 AM   #8
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Re: neural foraminal narrowing, MRI help please

As far as your work is concerned, I would think IF the hand problem is carpal tunnel syndrome, there is a stronger relationship between your work and your hand problem than your work and your neck. If you can get that sorted out, that may help your decision about work. The other thing to notice is when you are working, does it cause pain in your neck? If so, it is aggravating the situation and you'd be better off with a more sedentary job. Have you tried wearing a cervical collar? That can give some relief by limiting neck motion. Just take a neck circumference measurement, and a soft collar can be purchased by size. Wrist splints can help in the same way if you have carpal tunnel. Carpal tunnel affects the thumb, first 2 fingers and thumb side of ring finger. It spares the pinky. When your hands are burning, notice whether your pinky is involved. The pain will worsen with acute flexion of the wrist held for 15 seconds in CTS. That is a good test to sort that out. I agree that for neck surgery, you should get at least 2-3 opinions until you feel like you've found the right Dr. with the right plan.

 
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Old 11-11-2013, 09:50 AM   #9
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Re: neural foraminal narrowing, MRI help please

Thanks Webdozer,
Yes, I definitely do feel pain in my neck while working. Everytime I lift, which is often, be it 5 lbs or 40 lbs, I FEEL pain and very often burning running down my column.
Anything sedentary bothers my lumbar, which is herniated at L1-2 with space narrowing at LL23 and L45, L5S1, no severe stenosis. Sitting at computer, reading, TV all will bother me.If it acts up I treat with ice and stretches. I do walk 2miles a day ,job permitting. I am by no means inactive, my weight is perfect.
All fingers on rt. and left hands have pins and needles, with rt hand burning. In last few weeks I notice it definitely in ring fingers and pinkies, I look at my hands at 3or 4 in the AM [ because they wake me ] and often rt. hand is slightly swollen with burning.
I do show signs of carpal tunnel, but has not adversely affected work yet. Phalen's test somewhat positive.
I will look into collar and splints, thanks.
I will continue to work full time and hope neck situation does not get worse. Workmans comp for my neck was not my idea, hate doing it, it was just my only option to get to the bottom of this since neuro would not see me [see 1st. post]

 
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Old 11-11-2013, 10:27 AM   #10
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Re: neural foraminal narrowing, MRI help please

Also, would like to know if hereditary or developmental stenosis is ever addressed on MRI's. Where would I get that info? I will ask that question when I next see specialist. You and Ladybud have been great. What a wonderful service.

 
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Old 11-11-2013, 11:26 PM   #11
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Re: neural foraminal narrowing, MRI help please

I've read a ton of MRI's on this board, and many make me suspect hereditary stenosis. For example, if the radiologist talks about a "mild" or "moderate" intrusion into the canal impacting on the cord, I have to wonder. Is he misusing "mild" or "moderate", or is the intrusion really not all that big, and it's affecting the cord simply because there's not enough cushion (filled with cerebrospinal fluid) due to the canal being too narrow to start out with?

If a radiologist says something like a 3mm intrusion (osteophyte, or whatever) is reducing the canal to 6mm, then you KNOW hereditary stenosis is involved. Even then, the radiologist probably won't say it. I may have seen a total of two MRI's where the radiologist is explicit about it, and maybe 25 where I suspected it. In some cases, the poster has followed up and found that he did, indeed, have hereditary stenosis.

Something about your MRI makes me suspicious. Cord indentation at four levels? And no indication of the size/severity of the intrusions? Oh well... another LOUSY job by a radiologist, which is all too common. Fortunately, a NS will read the images himself. May hardly even glance at what the radiologist says.

As I said, though, this makes a BIG difference. Do you want to address the intrusions by removing them via a four-level ACDF? Or do you want to address the stenosis itself by decompressing from behind? I really hope you can get a fiull explanation of how things are and what your options are.

 
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Old 12-31-2013, 09:51 AM   #12
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Re: neural foraminal narrowing, MRI help please

Webdozer and Ladybud,I have been rereading your answers and still am confused and seeking clarity. My W.C. case is progressing slowly and am now waiting on nerve conduction studies.Possibly double crush or separate CT Dx. I asked my spine specialist about the narrowing being hereditary and he just waved it off as a could be but why ask. The cord indentation at four levels concerns me since it concerned you. I have seen many frightening MRI reports on this board, [Hmoser is one], and the frightening common denominator seems to be the foraminal narrowing seen in so many levels. As you have seen so many so so MRI's and ones that alarm you, how does mine compare? I must add that I am still able to work, however with much discomfort. W.Comp is putting me on modified 4 hr. days and I think this will help greatly.

 
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Old 12-31-2013, 12:34 PM   #13
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Re: neural foraminal narrowing, MRI help please

Unfortunately, there are multiple possible causes for your symptoms, and maybe even multiple actual causes. Cervical cord impingement, cervical foraminal impingement, lumbar problems, elbow or wrist nerve entrapment. Hopefully, nerve conduction tests will give you a better idea.

As for your spine specialists "why ask", that's simple... if you have cord indentations caused by relatively large intrusions into a normal canal, then if you have surgery, you'd want to address those intrusions directly by means of ACDF (anterior disk removal). However, if the indentations are caused by relatively modest intrusions into a hereditarily narrow canal, then the surgical approach could very likely be a posterior decompressive surgery, such as a laminoplasty. At least, that would be the case for a surgeon who's able to do something other than just ACDF's.

This is coming from someone who's had both a C3-4 ACDF, then later a C4-5-6 laminoplasty.

Of course, that's IF you have surgery, and it's not for me to conclude that you do or don't need it.

The kind of reaching-and-lifting that a checker does all day long would certainly put strain on the many muscles that anchor in the cervical spine. Straining those muscles in turn stresses the spine, so if you have nerve impingement, you'd get pain. I would say that it's a no-brainer that your job has contributed to your condition. Whether or not that gets you anywhere with WC is something I can't even speculate on.

BTW, does the "parasthesia" in your hands manifest itself in some digits more than others?

 
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Old 12-31-2013, 01:10 PM   #14
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Re: neural foraminal narrowing, MRI help please

Quote:
Originally Posted by WebDozer View Post
Unfortunately, there are multiple possible causes for your symptoms, and maybe even multiple actual causes. Cervical cord impingement, cervical foraminal impingement, lumbar problems, elbow or wrist nerve entrapment. Hopefully, nerve conduction tests will give you a better idea.

As for your spine specialists "why ask", that's simple... if you have cord indentations caused by relatively large intrusions into a normal canal, then if you have surgery, you'd want to address those intrusions directly by means of ACDF (anterior disk removal). However, if the indentations are caused by relatively modest intrusions into a hereditarily narrow canal, then the surgical approach could very likely be a posterior decompressive surgery, such as a laminoplasty. At least, that would be the case for a surgeon who's able to do something other than just ACDF's.

This is coming from someone who's had both a C3-4 ACDF, then later a C4-5-6 laminoplasty.

Of course, that's IF you have surgery, and it's not for me to conclude that you do or don't need it.

The kind of reaching-and-lifting that a checker does all day long would certainly put strain on the many muscles that anchor in the cervical spine. Straining those muscles in turn stresses the spine, so if you have nerve impingement, you'd get pain. I would say that it's a no-brainer that your job has contributed to your condition. Whether or not that gets you anywhere with WC is something I can't even speculate on.

BTW, does the "parasthesia" in your hands manifest itself in some digits more than others?

 
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Old 12-31-2013, 01:23 PM   #15
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Re: neural foraminal narrowing, MRI help please

Often, the parasthesia, and burning are the CT fingers, thumb,pointer, middle and half of ring finger. But just as often the entire hand,rt and left, including pinky.Definitely wrist pain at base of thumb also on left hand. So ulnar?, as well as CT? The WC Dr. is a spine specialist, not a neurosurgeon, he strongly feels surgery would leave me very unhappy as he says all 4 levels would have to be addressed. So I am wondering, without surgery, what my life would be like. I know you cannot answer this, but still, I have always been so active, seems daunting.

 
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