It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Arachnoiditis Message Board

  • Help understanding NCS

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 03-03-2011, 08:58 PM   #1
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Help understanding NCS

    New here, and first post...hello all!

    I would like help understanding my latest NCS.

    1) Decreased CMAP amplitudes in all segments, prolonged terminal latency and prolonged F-wave in the left peroneal motor nerve.
    2) Decreased CMAP amplitudes in all segments, prolonged terminal latency in the demyelination range and prolonged F-wave in the right peroneal motor nerve.
    3) Borderline prolonged terminal latency and borderline slow NCV in the PF-A segment of the left posterior tibial motor nerve.
    4) Low SNAP amplitude and borderline slow NCV in the right sural sensory nerve.
    5) Absent response in the left superficial peroneal sensory nerve.
    6) Normal NCS of the right posterior tibial motor nerve, left proximal sural sensory nerves, bilateral distal sural sensory nerves and bilateral peroneal motor nerves recorded over the anterior tibialis.

    Thanks for any help.
    HBrown01

     
    Sponsors Lightbulb
       
    Old 03-09-2011, 10:27 AM   #2
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    do you have a confirmed herniation/cord involement in the low back area that is rather impactful? it just appears they ONLY checked out all the lower areas with no upper so i am assuming? these types of studies are the best way to find areas of real true impairment/possible impingment of specific nerves, but they are very confusing to try and figure out on your own unfortuently. i have had three done now. it does appear whatever you have going on is HEAVILY impacting your motor/muscle functions tho(latency). and some sensory impairment. the motor nerves down in that area(very different in the c spine) at each vertbral level just naturally sit kind of right behind the actual disc level while the sensory nerves are kind of more at the back(anterior is front along with anything written as 'ventral", while anything in the back would be "dorsal" or posterior. just FYI for any future reference). so i am assuming that this is a rather large herniation of some other "thing' just IS definitely impinging upon that nerves vertebral level. or direct impingement by anything to the spinal cord itself could create the issues too.

    but basically with these reports/tests, anything that states 'prolonged or prolonged latency" pretty much means that it is taking way too long for that nerve being tested/stimulated to simply 'run' its more normal timing from the stimulation to the brain and back(it much more technical than that but thats the gist?). so "something" would be kind of 'interuppting the signal in some way(usually a form of impingement upon the nerve itself) or in some cases, it is not running to the brain at all which would indicate a full out total impairment of that particular nerve by something ON it or damaged it(you DO show an "absent response in your superficial peroneal sensory nerve on the L".

    have you had an MRI of the suspected area? what have your ongoing symptoms been? it just appears that, from this EMG/NCV that there IS most definitely direct impingement/impairment somewhere in the lower back area when looking at esp the nerves/muscles that were tested? and it should also state somewhere on that report "abnormal' emg/ncv too. i know mine does and i have alot of c spine crap and muscle damage/losses in my L arm/hand. there are some sites out there that can help explain this kind of stuff much easier. but these reports are written so like only a physiatrist or neuro would just fully 'get it' vs what we would.

    have you spoken to the doc about these results? they will usually tell you at least something after since they DO get/see the results pretty much right during that test and know what it is thats been tested? if you have not yet had an actual MRI done, you seriously DO need one after this test and results. there just IS definitely a 'something impacting something' and appears to be pretty impactful in some areas to cause the results there that needs to be found out. i hope this helped at least 'some'. marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 03-09-2011, 07:43 PM   #3
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    Marcia, thanks for your help.

    I am trying to get an increase in my VA disability and I did not post all the facts so I could get an unbiased opinion.

    The VA's conclusions and comments for the NCS is " There is no definite evidence of diffuse peripheral neuropathy. There were some borderline changes but not sufficient for electrophysiological diagnosis of peripheral neuropathy."

    I read the VA's conclusions as BS.

    I had a previous NCS and EMG in 2003 as follows...

    NCS:
    1. Prolonged TL of left median and ulnar nerves.
    2. Slow NCV of II-W and P-W segments of left median sensory nerves.
    3. Slow NCV of E-W segment of left median motor nerve.
    4. Normal study of left ulnar sensory nerve.
    5. NP in left sural nerve
    6. Markedly prolonged terminal and F-wave latencies, and low amplitude, of bilateral peroneal nerves.
    7. Prolonged TL of proximal left deep peroneal nerve.
    8. Normal study of right sural nerve, bilateral post tibial nerves, and jproximal right deep peroneal nerve.

    EMG:
    1. Increased insertional activity and PSWs seen in left L5 and S1 paraspinal muscles.
    2. Normal study of left gastroc, and tib, peroneus longus, vastus lateralis, and L3 and L4 paraspinal muscles.

    Conclusions and Comments:
    these electrophysilogoic findings are compatible with a left L5/S1 radiculopathy. However, because of prior lumbar surgery, we cannot distinguish between recurrence of radiculopathy, persistence of radiculopathy, and arachnoiditis. Clinical correlation is recommended. There is also evidence indicative of a peripheral neuropathy.

    Marcia, I first injured my back in the Army in 1973, and did not seek treatment until I had a total blow out of L4/L5 in 1988. I was in suicidal pain for a good portion of those years, but soldiered on.
    Now in my mid 50's I am finding it harder to get around; what with all the pain pills and arthritis that has now set in to stay.

    I had figured the VA was not telling me the truth in the latest NCS and I thank you for your input.

    HBrown01

     
    Old 03-10-2011, 05:48 AM   #4
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    intersting. did they ever actually 'do' a full MRI from the c spine on down the whole column? just considering that you also DO have some level of impact up in the c spine level at least with the ulnar and median nerves that DO run from the mid to lower c spine thru and down to the fingers? since i do not see anything written about that c spine levels of findings, were they chalking THAT level too as some type of actual neuropathy or radiculopathy? THAT does matter here considering that it appears your entire list of actual real findings is FROM that c spine and L spine but ALL mostly L sided?

    peripheral neuropathy and radiculopathy(the P neuropathy is more sensory losses than radicu(radicu stems FROM sp nerves down) in most cases, and PN can be a combo of both a bloodflow issue and nerve(both can create sensory loss when 'not flowing right"), but actual PN would not correlate specifically in most cases from the spinal nerves from that far up, since it "usually" starts FROM the outter/distal extremity(like the toes for example) that 'works' its way up TO spinal and not the other way around. while they can mimic each others symptoms to a certain degree, it can usually be figured out which one you have by getting very specific types of testing done AT the suspected impacted areas at that spinal level in some cases.

    i need to ask you a question. whenever you have had the more hands on neuro exams done on your legs and they hit your areas below your kneecaps with that little hammer, exactly HOW do your lower legs respond to the tap? just the more normal 'bounce out" or more "brisker/quicker" reflex or nothing at all? your answer would be rather telling depending.

    even a contrasted MRI can usually show older vs newer types of damage or impact, along with the always present post op level of actual scar tissue that is pretty much a given too, esp after all this time has passed. did they ever actually rule out the arachnoiditis? from what i have heard about that condition it IS very extremely painful and one thing I was VERY worried about developing after they had to cut thru my arachnoid outter layer and the other two spinal cord layers just to remove a glob of blood vessels from inside my spinal cord itself? we have the 'dural', "arachnoid", then "pia matter' layers kind of on 'top/surrounding' of the actual inner cord level.

    but if they have never MRIed you from that beginning area of the c spine on down at all, that c spine also NEEDS to be looked at down to the cord level as well. anything that simply is AT any particular spinal segment CAN impact many different things/nerves/ functions below the level of impact(even down to the toes) esp when it is spinal CORD level impact of some kind too. my spinal cord 'injury" is at the C 8 nerve level but within the left side of my cord mostly, and i have a TON of insanity FROM that level on down thru my legs to my toes.

    you can also have two or more levels of spinal problems going on at the very same time as well(i have both severe c spine crap AND an L4-5 annular tear with heavy stenosis in the L foramen too), but you cannot actually fully 'attach" ANY real symptoms TO a specific 'problem/issue' without at least looking at each level with what would be the best way, a contrasted MRI being done just to see esp right now, what IS impacting that L side of the c spine too? generally, all actual spinal nerve or even cord impact symptoms CAN be tracked back to the level and source just based upon YOUR actual symptoms and with your EMG results. but that test cannot tell what that 'something impacting' just IS without seeing whats there on a scan. sometimes it will be only one thing, like a larger herniation impinging nerves or it also can be more than one thing too all in that one specific area. and THAT just IS what MRI will show, the 'something(s)'.

    since your initial injury was really quite a long time ago, then it appears the lumbar surgery was in 88? i would think, just looking at what is present upon your newer emg/ncv that if you have not actually had whats recommended in your report as "clinical correlation IS recommended". which would be a good full spinal contrasted type of MRI just to see how much actual damage and that scar tissue formation is just there NOW in L spine(been ALOT of time passing since that surgery), you most definitely NEED to at this point. and you need to find out if there just IS something that would have to be right around both the c 6-7(median) and at c 8 nerve(ulnar) levels up in your c spine that is creating the fine motor and some sensory impacts too.

    are you having any symptoms to speak of in that L hand/fingers, or neck pain? if so, exactly what are you feeling and where? all the nerves from c 5 thru T 1 are what is referred to as the peripheral nervous system, with only T1 actually stopping at right about the mid forearm(with sensory innervation), and all from c 5-6 to c 8 actually innervate(both sensory and the fine motor/dexterity) down to the fingers.

    i would most definitely speak with your doc about setting up what that emg report is actually "asking" them to do, correlate with more testing with the MRI WITH a good contrasting agent esp in your case. and FROM the C down thru S spinal. you should probably get the full picture of the entire spinal column if that whole thing was never actually done yet, just to finally see that too for any issues considering you just were in the military at all,then time passing?

    how long HAS it been since they actually DID an MRI on you? hopefully they will simply go ahead and DO whats really needed to tell what the heck IS just goin on from top to bottom of your spinal. do not let them try and 'only' do a CT since that will NOT even begin to show enough of what simply NEEDS to be seen that only MRI will show all the way thru TO that needed spinal CORD level, just to make darn certain that NOTHING is impacting THAT at all in you. good luck with this and DO keep me posted HB. marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

    Last edited by feelbad; 03-10-2011 at 05:57 AM.

     
    Old 03-10-2011, 09:09 AM   #5
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    Marcia, I have had C and L MRI's. I will look them up and post the results.

    I have been dx'd with 32 illnesses and injuries...Lupus, Carpel Tunnel bilateral, Spinal Stenosis, Tarlov cysts bilateral at L5/S1. I go next Wed. to find out what they intend to do about bilateral torn rotator cuffs. I also have a severe medial meniscus tear in the RK.
    Pretty much beat up from head to toe!

    Sorry about all of your spinal problems...you can relate about all the pain, and stiffness.

    HB

     
    Old 03-10-2011, 01:31 PM   #6
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    1988 surgical notes:

    OPERATION: Right side, L4-5 laminotomy and disk excision (micro technique)
    OPERATIVE
    FINDINGS:
    The operative findings is sketched in the chart. The acute
    problem was related to a free fragment HNP which was contained directly above the L4-5
    of the L5 body, that piece of cartilage being coiled and rolled under an intact
    posterior longitudinal ligament through a tear in the anulus. A large fragment lay on
    that and was attached to the superior cartilaginous plate.
    The second finding and also a very important one was that there is major spondylotic
    change on the L4 body and to a lesser extent the L5 body. This led to an enormous hump
    its hardness. A lesser amount of spondylotic change was on the superior aspect of the
    L5 body. The nerve root even at the end of surgery appeared somewhat tight. .I had
    therefore the nerve root was encroached only from below and I could not do anything
    about this therefore I put a pledget soaked in Solu-Medrol over the root but insulated
    the apperature, the fenestration into the disk.
    patient in the prone position on the Wilson Frame. A distal lumbar incision was made,
    one longer than ordinarily used
    in
    a Micro surgical procedure because of the patient's
    skirt. An inch and half thick fat pad was retracted after incision exposing the
    lumbo-dorsal fascia. This fascia was incised longitudinally and then the muscles were
    micro retractor. A standard larninotomy was begun. Micro technique was used at this
    point. The bone was then first with the straight single action rongeurs
    then the
    ligamentus flavum was removed in blunt and sharp dissection and the bone work was
    within the spinal canal was the nerve root. It was elevated and displaced in the
    lateral direction by the enormous amount of material beneath it.
    Most of
    the early
    to begin at the distal one-third of the L4 body and then continued in the high hillock
    until it descended on to the L5 body. The center of this, however, was soft,
    fenestrated disk into a tear in the anulus and from that recovered the coiled
    opposite side of the fragment was attached to the body of L4. This was
    <0009>
    an
    enormous amount of disk material and this was finally delivered. After that the space
    as exenerated and carefully explored. I irrigated copiously there with bacitracin
    solution, then I performed the bone work laterally and a true
    frailinotomy,
    preventing
    subarticular or lateral recess stenosis. I then explored both above and below the
    space. We could find only a hard bar on both edges. The tear in the anulus was
    palpated to about the midline and was explored directly and with the hooks. No
    disk material was
    available. I
    irrigated again copiously, checked for spinal fluid
    leakage with valsalva and then placed a bit of
    jeilfoam soaked in
    Solu-Medrol over the
    L5 nerve root.

    HB

     
    Old 03-10-2011, 01:35 PM   #7
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    2007 CT:

    CT pelvis without contrast.
    Indication: 51 year old man with SLE and psoriasis.
    <0009>
    Please
    evaluate for sacroiliitis.
    Comparison: Spine SI joint radiographs dated 01/24/2007.
    Findings: A minimal amount of sclerosis seen in the right
    inferior sacroiliac joint, adjacent to a marginal osteophyte, and
    is most likely degenerative in nature.
    <0009>
    The remaining portion of
    the right sacroiliac joint, as well as the left sacroiliac joint
    are normal in appearance.
    Significant anterior marginal osteophyte formation involves the
    visualized portion of the lumbar spine.
    <0009>
    Discogenic degenerative
    changes are also present at the L5-S1 level, with minimal midline
    protrusion of a calcified density into the vertebral canal, which
    does not appear to compress adjacent soft tissue/neural
    structures (series 1, image 15 and image 29 on reconstructed
    images).
    <0009>
    The bilateral hip joints are intact with minimal
    degenerative change. No other osseous lesion is identified.
    The visualized portion of the
    <0009>
    large and small bowel is normal
    in appearance.
    <0009>
    The urinary bladder is collapsed, and appears
    normal.
    <0009>
    The prostate has a normal size, with scattered
    parenchymal calcifications. Additional parenchymal
    calcifications seen within the bilateral seminal vesicles.
    <0009>
    Mild
    atherosclerotic calcifications are seen within the distal
    abdominal aorta and both common iliac arteries.
    Impression: 1.
    <0009>
    Degenerative changes involving the right
    sacroiliac joint.
    <0009>
    No evidence for inflammatory changes
    involving either SI joint. 2.
    <0009>
    Lower lumbar discogenic and
    degenerative joint changes, most prominent at L5-S1.
    <0009>
    If there
    is clinical concern for neural impingement/compression at this
    level, MRI of the lower lumbar spine is recommended. 3. Minimal
    degenerative changes in the hips bilaterally.
    No evidence for inflammtory arthritis to suggest Psoriatic arthritis - pain &
    stiffness most likely associated with underlying DJD (although CT not done with
    contrast). Will continue with conservative therapy for now with NSAIDS,
    narcotics & PT. If clinical picture evolves or failes to improve with said
    therapy may consider repeating the CT with contrast.

     
    Old 03-12-2011, 10:12 AM   #8
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    hi HB. sorry it took today to get back to you. but i spent yesterday reading thru alll of what you posted and trying to really understand some things/look up some things. one HUGE thing i am wondering here just considering that the CT and then the EMG/NCV also both recommended 'clinical correlation/further deeper testing" like with at LEAST a contrasted type of MRI esp with having old and new issues(not to mention an actual surgery), did you EVER actually obtain that test? that one type of MRI seriously IS just crucial for you at this point just to better see the findings that popped up in even a NON contrasted CT along with the overall results that came up with your latest test, the EMG/NCV which unfortuently just DOES show alot of different both muscle and nerve issues and one "absent" flow velocity in at least one nerve in your leg? once that MRI better "defines' the more critical areas of problems, THEN it allows your orthosurgeon and you to come up with the very best ways of trying to 'treat' the problems, but they have to be identified on that MRI first BEFORE anyone even CAN 'do' anything to try an at least help alleviate your pain/symptoms.

    there just were some rather critical, and very MUCH THERE findings that showed up even without contrast that need to be more deeply seen WITH contrast used in an MRI right now so YOU and any docs will just better know what IS a 'still there' types of issues(as well as ANY problems just stemming FROM that surgery as well. that contrast CAN define whats older and newer too) and anything newer that has occured simply by aging and time passing, and LOTS of movements you have just 'done' over decades that can tend to create or also exascerbate certain issues, esp within ANY joints. i am just kind of wondering why they even did an actual CT without using what is pretty standard WITH doing any CT on someone, a contrasting agent of some kind? this just DOES tend to 'flow into' areas that are 'suspect' for possible problems that would NOT always even begin to actually show up without contrast being used. but at any rate, that MRI should have been done way before now simply based upon what WAS "recommended" per CT, and now with TWO seperate types of tests?

    i am also wondering just what this surgeon did or better yet, what he did not do back in 88? whenver you remove a large portion or all of a persons actual 'disc' in the spinal anywhere, they simply either HAVE to replace that disc with 'something'? it is usually a bone plug(either from a bone bank or your own hip bone) that would eventually fuse together both the vertebraes/endplates on the one above and the one below the actual disc level that is or was damaged/removed or extruded? it appears from your op notes(thanks for for providing those by the way, they DO help) that what was referred to as an 'enormous amount of disc material' that had actually extruded out and was found to be in some really insane way as well and 'coiled up' under your ligament was actually removed, but nothing was ever 'replaced" into that space at all to simply compensate for the now missing disc? i am just thinking that considering the overall 'amount' of actual disc material that was 'free floating as well in there that he did not think of, or thought it was not important enough to even TRY and 'do something' to better protect the endplates and what CAN just happen to the actual nerve roots when there IS NO real 'cushion/shock absorber that WAS the discs main job. any potential 'disc portion' that was possibly 'left behind" more towards the front of that particular level, would, over time also tend to start a bit of 'wedging" towards the back side where NO "rest of the disc' simply sits anymore too? that would be just gravitys effect on a freespace with no structure to support the posterior part of the vertebrae which is under alot of pressure/compression anyways?

    do you ever 'hear/feel' any type of actual bone against bone type feeling there in that lower? if nothing is there, the bone ends WOULD be creating a rubbing/friction action when you move the back(and also possibly impacting or impinging nerve too. there are also 'other more 'incidental findings there too that are in your lumbar and the SI joints that actually showed up on that CT too that need a much closer look into to see what impact they are simply also having on you/your symptoms of very real nerve impairment.

    i am kind of running out of time here right now HB, but just but in summary here, wanted you to know i HAVE read thru your stuff and you seriously just DO definitely NEED a good contrasted MRI right now before anything can truely even be sorted out as to what IS generating what and how bad that area actually is. i will hopefully be able to get back here tomorrow to tell you the rest of what just my own personal thoughts are on what i read about your situation. just DO speak with your main treating doc and make certain to also show them just what IS and has been an "ongoing recommendation" showing up at the end of all reports, the need for deeper testing/correlation with contrasted MRI. that 'should be enough" to obtain one now. marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 03-12-2011, 11:14 AM   #9
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    Marcia, thanks for the reply...I have the MRI with contrast from 2010 sitting on my desk. I have not had the time to scan it in so I can copy/paste. My carpal tunnel does not allow much typing.

    I will get it done latter today...right now I am wheel borrowing sand to fill in low spots In my yard.

    HB

     
    Old 03-12-2011, 01:11 PM   #10
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    Marcia, I finally had time to scan the MRI...Again, thanks for your help.

    NAME: BROWN,H WARD/CLINIC:
    REQ.PHYS:
    AGE: 55 DATE OF EXAM: OCT 7,2010 14:26
    DOB:00-00-1955 REPORTED: OCT 8,2010
    CASE NO: 1571 TRANSCRIBED: OCT 8,2010 11:07
    EXAM: MRI LUMBAR SPINE WO & W CONT
    (Case COMPLETE) MRI LUMBAR SPINE WO & W CONTRAST (MRI Detailed) CPT:72158 Contrast Media : unspecified contrast media
    Reason for Study: Low Back Pain
    Clinical History: Low Back Pain
    Report:
    MRI of the lumbar spine
    Indication: 55-year-old male with lower back pain.
    Technique: Sagittal and axial T2 FSE, sagittal and axial Ti, and sagittal STIR. Post contrast sagittals and axials were also performed.
    No prior available for comparison.
    Findings: Lumbar spine alignment is normal. The conus medullaris is at Li-L2. Bone marrow signal is within normal limits. No abnormal signal is seen within the spinal cord. There is desiccation of L3-L4, L4-L5, and L5-S1 interavertebral discs.
    L1-2: Normal. L2-3: Normal.
    L3-4: There is a small broad based disc bulge resulting in mild bilateral neuroforaminal stenosis (left > right).
    L4-5: There has been prior right L4 laminectomy. There is a moderate sized disc bulge resulting in bilateral
    neuroforaminal stenosis with no significant nerve
    impingement . There is mild canal narrowing. Bilateral perineural cysts are also present at this level. Moderate facet arthropathy is noted at this level.
    L5-S1:There is a moderate sized disc bulge with superimposed left paracentral disc protrusion and mild facet DJD resulting in moderate right neuroforaminal stenosis with the disc touching the exiting nerve root. There is also indentation of the transiting left Si root.
    Postcontrast images reveal minimal thecal sac enhancement at L5-S1 level. There is no evidence of epidural scarring.
    No significant abnormal enhancement is identified within the lumbar spine or distal thoracic cord.
    Impression:
    Mild-moderate degenerative changes at L4-L5 and L5-S1 resulting in bilateral neural foramina narrowing at L5-S1 and compression on the exiting right L5 and transiting left Si at this level. Mild canal narrowing at L4-L5 results in indentation of the transiting L5 nerve roots.
    AS THE ATTENDING RADIOLOGIST, I HAVE PERSONALLY REVIEWED AND INTERPRETED THE IMAGES AND AGREE WITH THE WORDING OF THE ABOVE REPORT.
    Electronically signed by: Date: 10/08/10


    HB

     
    Old 03-14-2011, 08:49 AM   #11
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    hi HB, once again, spent yesterday going over what you posted. i needed to better understand some of your findings. the one thing i am wondering here with regards to your c spine MRI you said you had(would be a problem kind of around c 6-7)? did THAT show anything else that could be affecting your median nerve other than possible carpal tunnel within your wrist? i believe you also had ulnar issues as well(the ulnar IS a free nerve at the C 8 nerve level with NO real vertebrae to call its 'own')? this is just a situation where ANY other potential generators NEED to be ruled out AT the c spine level too, not just 'assuming(do not know if doc did that or not) that this just IS CP syndrome. tho it IS the median nerve that is the nerve that happens to run thru that CP tunnel, but with the ulnar findings as well, it just 'could be' from a c spine related problem too. THAT 'finding" simply NEEDS better definition just to even know exactly where THAT finding IS generating from.

    with regards to your 'multiple tarlov/perineural cysts goes, having actual tarlovs even develop as one cyst thats shows up within the 'sheath" between nerve and the outter protective sheath covering it IS considered rare, but having 'multiples" is even MORE rare as far as occurance. trust me, i have 'rare' crap too and it does suck, only becasue not AS many surgeons even KNOW enough to actually try and treat the particular issues. the gist of what i got in really reading up on these(have had others post about them here before but really never looked up exactly what they are or how they form or impact) this could possibly explain a good part of your pain too not only becasue the nerve root is being compressed, but also from a very definite raise in the overall CSF fluid pressure that simply runs within the dura and the brain IN that membrane(the dura or thecal sac) surrounding your cord too. while it stated they form only in the sacral area, i KNOW the people have posted thiers above that level too. per your MRI it states thankfully that your individual 'conus' stops at the very beginning of your lumbar. the 'conus" simply is the very end of where any givern individuals actual spinal cord terminates or "ends" so yours DOES stop well before your level of spinal issues/and cyst development too, and considering what these cysts could just do to someones cord level, thats huge for you, trust me. the 'average" conus in any given person, generally ends somewhere between the last T spine level and into possibly up to L 3 in some cases. its just different in every individual, not an 'always here' type thing?

    has anyone ever really explained to you just what the tarlovs are and how they develop and where? depending upon how many their are(tho sounds like only two that are bilateral, meaning one on each side) it does not state at exactly what real level there are located at per the MRI. but i am guessing here based upon a statement your surgeon made in his op notes tho about that L 5 nerve root being rather "overly tightened" or something to that effect, that at least one of them IS a location for one of them. if he stated 'bilateral', it could simply mean that you have one within each L 5 on each side too. you DO need to find out from a good neurosugeon a few imperitive things like THAT exacting location and how large they are too.

    while reading thru just what can actually be done with these lil suckers, they DID mention a few potential options? the thing is, while they CAN simply aspirate the CSF out of each cyst, over time, the area simply DOES tend to "refill itself unless the very beginning opening or "neck" of that cyst is blocked off. i have the same issue with my polycystic kidney disease too, they CAN aspirate out what is in MY cysts, epithelial fluid, but the lil sucikers just WILL fill back up again. but the one thing that CAN show if the tarlovs or your actual spinal IS the most major source of your pain and symptoms WOULD be to aspirate out that fliud(since it takes a bit(days/weeks) to refill) and just see how your pain actualy is immediately following the procedure. its just one possible that would show what IS generating at least some or even the worst of your pain and symptoms anyways just by temporarily taking that added pressure OFF the nerve root. you would simply have a good 'window' of time there post aspiration enough to tell what may be stemming from cysts or spinal structual issues. you just also DO unfortuently have quite a few other findings structurally there too.

    do you EVER actually get unexplained headaches ior just headpain at all?

    they do do alot of rule in/ rule out types of testing like this to better define actual pain generators by taking one possible generator out of the picture temporarily. the way they determine if someone has RSD(a nasty pain syndrome i have inside my knee) for example is with whats called a sympathetic nervous sustem block? i have a sympathetically generated pain syndrome in my R knee from symp damage. by doing a symp block and blocking all the SNS signals from just going into my R leg at all, my pain DOES go way down, thus a 'positive' result from the symp block and an actual dx of RSD for me. yippie. but do you understand what i am trying to say?

    right now you DO have lumbar impact issues,along with at least some involvement of your SI joint, which is NOT at all uncommon esp if lifting alot of heavy things moreso on one side vs the other, usually YOUR more dominant side. and also those cysts too which very MUCH DO impact your overall cerebrospinal fluid levels within the surrounding of your cord, and the canal further down dura. just even 'being there at all", they can also congest the dura,and YOUR actual lower canal does state its 'narrowed too(just becasue the actual cord stops, does not mean the fluid also stops there or you never would have GOTTEN the tarlovs to develop at all since they ARE filled with CSF) and not even allow a full/normal 'ebb and flow" of that needed CSF to just run the way its supposed to, from the brain on down one side then when it reaches the very end of the sacrum, it runs back up the opposite side in a very 'timed' flow back to the brain where it DOES constantly get replenished like every four to six seconds, then the process starts again. this 'process simply keeps your actual cord and nerve roots 'bathed' with liquid so they do not dry out? but even beyond the end of the cord, there still are alot of nerve roots that run thru that area down below where you are having the most issues too.

    i seriously would very highly advise you to simply 'do' some searching on tarlov cysts and what types of possible treatment is being offered too. i found a ton of info this way on them that you having them also NEED to be aware of just what it is you are dealing with too. this IS the other 'half' of a possible good solid pain and radiculopathic symptom generator that is also impacting the nerve roots and creating pain. that CSF is actually somehow been 'forced' by probably too much pressure and some level of weakening(which CAN be congenital too,or from YOU yourself also having a certain level of a connective tissue type of disorder as well) in the outter sheath covering each nerve root. that CSF simply gets in that spot between the actual nerve itself and the outter covering which i am assuming would be your mylen sheath, then starts to kind of 'balloon out' around the nerve and THAT plus the outter forces exerted BY just the ebb and flow of the intradural CSF would exert even more real pressure ON that already inflammed nerve root in there, then more pain and symptoms result. its a rather nasty cycle. HB, you really just DO NEED to find out as much as possible about tarlovs. look up both tarlov and perineural cysts, this should bring you to some needed info.

    i just wanted to mention something i saw when reading thru your op notes the other day? it is stated that this surgeon did what was called a 'frailinotomy"? there is not any procedure i could even find that stated what THAT actually even was, so i am thinking what was 'ment' to be stated AS that procedure which DOES make alot of sense given what he was trying to do there would be whats called a 'foraminotomy' instead? this IS a procedure where they simply better remove/reem out the actual foramen where all nerve roots go thru from the spinal cord. it would make sense that per the way this was simply written that he wanted to give that particular foramen more "room" so it would not become impinged upon soon? i was going to mention that before but forgot and just happened to remember it now for some odd reason. the crazy thing here, and this just 'could be' caused by those tarlovs, is you STILL have foramaminal narrowing at L 5 and S 1(also 'something' indenting S 1, possible cyst would just do that)? it states that is also bilateral as well as those tarlovs being bilateral, so i am kind of assuming here. it simply does NOT actually state whether the foramens have ANY actual stenosis which is usually the 'narrowing' that gets created in most foramen, so the 'bilateral cysts there at that particular area just make sense as the 'culprits"?

    your L5 also is stated as having DJD(degenerative JOINT disease) that means it is detertiorating in some way too. what i would seriously do here if i were you is look for a really good neurosurgeon to get a consult and eval from. the ones that you can actually just see in any of the many different teaching type of university hospitals generally have alot more knowledge and also experience in simply seeing the more "rare" and crazy types of spinal issues, just BECAUSE it is a teaching facility, they do tend to see more and also are more aware of the latest treatment options out there too. and some are doing their own trials or know of them as well. with my 'rare' glob sitting inside my spinal cord, i went to our local U of MN here and found the BEST out of three NS opinions from someone who simply had had many YEARS/decades of ongoing treatment and surgical resection of what i just happened to have. the other two NSs were flippin clueless as to what this glob even ment for me at all and more a less blew it off, when it had also already bled once too which no one EVER told me til i did get to the one NS at the U who told me i had an active bleeder. go figure.

    anything that is presented at these types of facilitys are also really great 'teaching cases" as well so they just are more likely to try and help you with whatever knowledge they actually have and look up in many different places they just also have availiable, other potential options for you too. they DO have a more refined type of "databases' availiable to them that other docs/surgeons really do NOT or are not privy too as well.

    but either way, you just DO need a really good knowledgable and experienced type of neurosurgeon to first fully go over all testing an a really in depth hands on eval too, then a good consult with him or her to really find out exactly what it is you are dealing with and what just can be done to help alleviate your pain and symptoms. and of course to find out WHAT involvement the tarlovs are having and what IS structural. it just appears that once your spinal cord ends, everything just gets a bit crazy from there, ya know what i mean? they also NEED to find out just how high YOUR individual CSF pressure also is running as 'your normal' too since the higher that pressure just is, the much higher risk of developing tarlovs just is(have they ever actually done a spinal tap?). esp if you just were also born with some type of "connective tissue" weaking or predisposistion which from what i saw can be much more easily instigated/brought on from any good level of actual 'trauma' which i KNOW you did suffer in the military. but trauma of some kind to THAT specific area almost always IS what will start the tarlovs forming. in most cases anyways.

    just DO really inform yourself here HB, you would be amazed at what is out there to help you better understand these. its just a part of you that you have to learn more about in order to even KNOW what the potential treatment options are and what these just mean for you too/prognosises. this is what I perosnally would be doing if i were in your shoes right now.

    if you have a copy of the c spine MRI done, i would love to see what findings showed up. but when you actually got that done would also matter too. hope this all helps some, marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 03-15-2011, 08:35 PM   #12
    HBrown01
    Junior Member
    (male)
     
    Join Date: Feb 2011
    Location: Hartselle, Al. USA
    Posts: 10
    HBrown01 HB User
    Re: Help understanding NCS

    Hello Marcia:

    I have been studying the tarlov cysts for some time now, but I have not had a nuro appointment too discuss it with the Dr. Getting an appointment at the VA
    for nuro takes some time. Most of the disabled soldiers have some type of back injury.

    On the headaches...I keep a headache most of the time. It gets worse when I cough.

    I found the C MRI that was done in April 2003. They also did a L MRI at the same time.
    C6-7 shows severe neural foramen narrowing. You were spot on, on that.

    It is getting past my bedtime...early Dr. visit tomorrow.

    I will get the results of the MRI's posted by the weekend.

    Where do your find all the time, and energy to type? My hands and forearms knot up after just a couple of min of typing.

    Thanks
    HB

     
    Old 03-16-2011, 09:52 AM   #13
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    honestly HB, despite the lil happy dance finger spasms i keep getting in my L hand/fingers, typing has been a great form of PT for my missing fine motor muscles(if i actually have to stop like even days, it regresses amazingly fast). it actually IS/was how i even GOT any good dexterity/pressure ability to 'push' back right after my sp cord surgery knocked them out . the rehab hosp i was in to deal with the 'lame hand' and the knock out of my L leg(that actually totally crumbled under me when i went to stand the very first time, 4 days post op), really helped me soo much by simply allowing me time on a computer. but i did have to actually lift up my left hand fingers with my R hand and manually place them onto particular keys, then push that key down still with my R hand until after ALOT of ongoing repitition/time, i finally started to gain strength and new memory by the typing and other excercises too.

    i just have to do things in 'stages', or things WILL start spasming and doing all kinds of crappy stuff to the L fingers, including also spasm/hold which always creates pain til it decides to let go. but i AM thankful just getting anything back after what i thought was going to end up being a totally completely 'useless' hand. it really IS astounding at what one CAN even regain again after even cord level damage. eight fine motor muscles were lost in that L hand which seriously impacted alot of my normal 'push/pull/ and esp pinch since my thumb seriously IS the most damaged. but you learn to "compensate" over time. but this IS why i cannot use the shift key unless i totally stop typing and just 'do' that? that got wayy too time consuming and draining my hand energy, soo now we type in all smalls mostly. and that is why my typing just looks like crap,lol.

    ya know, just considering your 'dx' of carpal tunnel alone? the one thing that you/any surgeon who may be contemplating surgery for CP, NEED to make certain of here is that you even actually HAVE "that" when you just DO also have what appeared in 03 as some pretty impactful(stated in 03 as SEVERE) impinging of THAT same exact median nerve that just also is the one that passes thru that carpal tunnel too? NO other nerve BUT that median actually passes thru that carpal tunnel, so it needs more testing and definition if you should EVER even contemplate "doing' any CP type of release surgery in there? too many people have actually gone thru that level of surgery when their stupid surgeons never even bothered to simply check out ALL possible areas(the c spine) that could also 'mimic' CP syndrome. the surgery should have been ON that c spine impingment and NOT actually the carpal tunnel itself, ya know what i mean? CP for some reason will 'usually' show itself moreso in the middle finger than the forefinger(tho both innervated by the median nerve) for some reason. so if you are NOT having ANY pain or symptoms actually IN that middle finger, i would suspect the c spine moreso than the CP as the real 'base' there.

    were their ANY other real hard findings around that C 8 level nerve? if there was nothing back in 03, but 'something' appears to be affecting now based upon your latest EMG study. that C spine area most definitely needs to be included in ANY MRIs that may get ordered now. BUT, depending upon exactly what just IS creating the foraminal narrowing on that c 6-7, that SAME finding that is doing THAT, just could also be affecting the c 8 NOW too. it all depends upon the 'impact' of what the real 'impinger/narrower just really 'is' at c 7. does it state exactly WHAT is creating that c 6-7 narrowing? it can and usually is some level of actual stenosis actually IN that foramen itself, but it can also be by a significant herniation or bone spurring like what would be usually called in any rad report as ' a rather significant osteophyte complex' or something along those lines? if this is enough to 'do' to the c 7, it could also be the underlying "impact' of the c 8/ulnar which is located exactly under that c 7 vertebrae with no real protection not having its own vert?

    if these findings were there in 03, i would imagine alot of real progression would also have come along for the ride too(we ARE talking like 8 years here?). its just how some spinal crappy stuff will progress or get more impactful over time and more wear and tear/movements we just 'do' with our heads/necks that some can really be more impactful on the spinal than others, esp c spine stuff.

    hopefully you can get the needed MRI with a contrast agent added which WOULD highlight more and also show older vs newer findings much more clearly too. and seeing a neuro really IS a critical thing for you too. most low back stuff can be handled by an ortho surgeon, but what your findings simply 'are' really does require the overall expertise of a good knowledgable neurosurgeon HB. hopefully you can at least obtain the needed MRI by some other doc writing the order while you wait to see the NS? it would save time and hassle when you DO get to see him, ya know? this way you would already HAVE the newer MRIs right in hand at that initial visit since he is going to be sending you anyways(they simply want and need the MOST possibly updated MRIs, esp if contemplating ANY surgical intervention). good luck in getting this all situated HB. as usual, do keep me posted, marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 03-18-2011, 07:13 AM   #14
    sammyo1
    Senior Veteran
    (female)
     
    Join Date: Jul 2007
    Location: USA
    Posts: 2,520
    sammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB Usersammyo1 HB User
    Re: Help understanding NCS

    Marcia is right. I was Dxed with Carpal 3 months after my fusion. I had a 3 day hospital stay & after was sent for the EMG. I knew there was no way I all of a sudden developed Carpal. Even my PM was doubtful that it was just CT.

    I started coming across others with Cervical/spinal problems that had the same diagnosis. Thus far its over 10 people Ive spoke with. As time goes by those symptoms are progressing & my PM just stated even if there is some degree of CT he believes its coming from cervical & I have not one single doubt.
    It can be pretty confusing & misleading when the spine is involved.
    I wish you the best of luck & God bless, Sammy

     
    Old 03-26-2011, 07:35 AM   #15
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help understanding NCS

    HB, sammy IS very right about what she stated there. i know sammys whole freaking c spine history,and trust me, it IS insane too..

    just checking in/up on you since i have not heard a peep outta you lately? how DID your doc appt go and what was THAT for specifically? and how are you just 'doin' at this point,anything new pop in to change things or terrorize you?? just give me a lil shout here when you can, since you just have been on my really teeny tiny lil mind here, or what i simply have even LEFT of it,lol. i DO hope all is going okay with you HB. marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Help with CT Scan Report kujo85 Spinal Cord Disorders 4 02-21-2011 10:45 PM
    Help - I'm the 10% MJml Spinal Cord Disorders 75 09-04-2010 09:26 AM
    New - need help understanding my ct results.. chronic pain....help please? LoraB Spinal Cord Disorders 12 08-28-2010 08:56 AM
    Help me in understanding my MRI report rkmgkm Spinal Cord Disorders 5 10-31-2009 03:56 AM
    Help with my Dad's Situation, Any alternatives? DRX9000? kennyyboy Spinal Cord Disorders 9 10-14-2009 12:14 PM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 04:57 AM.





    2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!