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marymmcc
08-13-2017, 12:39 PM
I just received my latest neck MRI and would appreciate anyone's help in interpretation.
I have ankylosing spondylitis and long standing degenerative neck problems. I am now experiencing vertigo along with neck pain, stiffness, parasthesia in arms and legs, and cognitive impairment (apparently not related to my neck) I take Tramadol, Gabapentin, and a biologic called Cimzia. My results follow: Do you think surgery is indicated? relationship of neck issues and vertigo? Thanks in advance.
FINDINGS:
The alignment is preserved. The vertebral bodies height and morphology are preserved.
There are no suspicious features of active or chronic kilos spondylitis. There are mild
sclerotic/modic changes in the endplates of C5/C6 posteriorly. The craniocervical
junction and C1-T2 articulation are grossly intact.
Multilevel degenerative changes as follows;
At C1/C2, slight hypertrophic ligamentous changes resulting in slight narrowing of the
anterior thecal sac.
At C3/C4, there is broad-based posterior central disc osteophyte complex resulting in
narrowing of the anterior thecal sac and focal abutment of the anterior surface of the
cord on the left side. No signal abnormality in the cord to suggest myelomalacia. This
has progressed from previous.
At C5/C6, slight reduction of the disc height with broad-based posterior disc osteophyte
complex asymmetric to the left abutting the anterior surface of the cord. No cord signal
abnormality to suggest myelomalacia. There is ligamentum flavum hypertrophy slightly
narrowing the posterior thecal sac. There is resultant mild central canal narrowing.
Along with uncovertebral arthrosis, there is moderate to severe right and moderate left
foraminal narrowing. These changes are stable.
At C6/C7, broad-based posterior disc osteophyte complex slightly narrowing the anterior
thecal sac. There is uncovertebral arthrosis resulting in moderate to severe bilateral
foraminal narrowing.
At C7/T1, small posterior central disc protrusion eccentric to the left. Mild ligamentum
flavum hypertrophy.
At T3/T4, small posterior central disc protrusion eccentric to the right side. This level
is stable.
At T4/T5, small left paracentral disc protrusion.
At T5/T6, small posterior central disc protrusion eccentric to the right side.
The visualized cord signal abnormality, position and volume are unremarkable.

IMPRESSION:
No features of ankylosing spondylitis.
Multilevel degenerative changes, relatively stable with exception of progression of the
disc osteophyte complex at C3/C4. No myelomalacia. Multilevel foraminal narrowing.

teteri66
08-14-2017, 09:39 AM
I would say this MRI brings good news, although that knowledge does not resolve all your symptoms.

I wonder who diagnosed you with ankylosing spondylitis? I ask because the first line in Impressions is "No features of ankylosing spondylitis. ". Not just that there are no changes...but, no features...

There are continuing degenerative changes in the cervical spine, but the alignment is good and there is no loss of disc height. There is some narrowing of the foraminal openings...which puts pressure on these spinal nerves as they exit the spine and go out to the area of the body that nerve innervates. You can look online for a "dermatome map" to see which nerve innervates which area of the body.

I will write more later...I am on a trip and the family is ready to leave for the day...so will finish my comments later today.

marymmcc
08-14-2017, 11:20 AM
I would say this MRI brings good news, although that knowledge does not resolve all your symptoms.

I wonder who diagnosed you with ankylosing spondylitis? I ask because the first line in Impressions is "No features of ankylosing spondylitis. ". Not just that there are no changes...but, no features...

There are continuing degenerative changes in the cervical spine, but the alignment is good and there is no loss of disc height. There is some narrowing of the foraminal openings...which puts pressure on these spinal nerves as they exit the spine and go out to the area of the body that nerve innervates. You can look online for a "dermatome map" to see which nerve innervates which area of the body.

I will write more later...I am on a trip and the family is ready to leave for the day...so will finish my comments later today.
thanks for your reply.
In answer to your question about my ankylosing spondylitis: my AS is confined to my Sacro-ileac (SI). My neck issues have always been degenerative.
I am concerned about the multi-level stenosis and the progression of my symptoms.I will check on line for the dermatome map.

teteri66
08-15-2017, 07:20 AM
Interesting that the AS is confined to the SI joint area. Obviously foraminal stenosis can cause just as many symptoms as central canal stenosis. They just aren't as devastating ultimately.

While there is slight cord compression, it is not causing myelomalacia ( which is what we really worry about), but it has progressed at C3-4 from the previous MRI. This is caused by the expansion of the disc osteophyte complex process.

I imagine there are some surgeons who would suggest surgery to clean out the foramina. I imagine this would also involve fusion of several levels to stabilize the segments and to keep the cord compression from progressing further. But, perhaps surgery is not necessary at this point.

I assume you are under the care of a spine surgeon. You might consider getting an opinion from a second spine surgeon just for comparison.