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    Old 07-17-2015, 09:55 AM   #1
    inspirations7
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    New here - Confused about MRI

    Hello,

    I'm new here, and will try to make this short as possible.

    I've had lumbar and cervical issues for a while, with pain. But as I've gotten much older, I have little pain. I also have polyneuropathy and a few other things. I went to my neurologist in early June with off-balance problems and my legs, individually, giving out. My left leg completely gave way and didn't come back for several minutes, which scared me. Also, I had what I call wrist drop, individually, with both arms--comes and goes. So, my neuro had me have lumbar and cervical MRIs. When they came back, he felt I should see a neurosurgeon.

    When I saw the neuro, all he had was my lumbar MRI, which was abnormal.

    Severe left neural foraminal stenosis at L4-L5 secondary to herniated disc along with degenerative and hypertrophic changes of the facet joint.

    Right paracentral herniated disc with compression of the S1 nerve root at L5-Sl.

    Severe degenerative dis disease at L4-5 and L5-S1.

    He said he'd seen worse, but he was concerned about my being off-balance and made me close my eyes and stand, wherein I kept leaning backward. He asked the neurologist for my cervical, since he wasn't sure if it was the polyneuropathy or my neck. That was June 30. I have yet to hear from him.

    Cervical:

    Had flattening and splaying of the cord at C5-C6, among other things.

    Impression:
    1. Cervical spondylosis multifactorial from C3-C4 through C6-C7.
    2. Disc spur complex at C4-5 resulting in some central cord stenosis and moderate to severe left neural foraminal stenosis.
    3. Diffuse disc protrusion with moderate to severe left neural foraminal stenosis at C5-C6.
    4. Left paracentral herniated disc at C6-C7.
    5. Severe degenerative dis disease at C4-C5, C5-C6, C6-C7.
    6. Retrolisthesis at several levels most prominent of C5 on C6 and C6 on C7, likely degenerative in nature.
    7. Normal signal within the spinal cord.

    Question: Why would he be waiting so long to contact me, after saying he would in two days? And, how serious is this? I'm in no pain right now, only the leg and off-balance prob. I did have what felt like nerve pain in my legs for one day, very painful, but it stopped.

    Thanks for any help. Sorry it's so long.

     
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    Old 07-19-2015, 05:18 PM   #2
    teteri66
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    Re: New here - Confused about MRI

    Welcome to the board. My first question to you concerns the poly neuropathy. How was this diagnosed and by whom?

    The reason I ask is because your spinal stenosis is sufficiently severe that it could be the cause of all your nerve symptoms. Have you had other MRIs in the past?

    I cannot say why the neurosurgeon did not get back to you other than he is busy and your case appears to be complicated.

    Your lumbar stenosis is severe enough that it alone could be causing your leg problems. The spinal nerves that innervate your legs are severely compressed and in all likelihood will not get better without surgical intervention. But you also have cord compression in the cervical spine which can also have an effect on the legs as well as the upper body.

    The loss of balance is also most likely caused by this nerve damage. It affects the proprioceptors in the legs. I have the same issue caused by nerve damage of the lower lumbar spine. I had severe lumbar stenosis and had my first surgery in 2008.

    Your cervical issues are of more concern than the lumbar ones due to the fact that the spinal cord is at risk of becoming damaged with the cervical issues. This results in a greater risk of potential paralysis than the lumbar stenosis. This is due to the fact that the spinal cord terminates around the L1 level in most people. Beyond this point, the nerves gather together into a big bundle that is called the cauda equina, so named because early doctors, upon seeing this bundle, thought it resembled a horse's tail. When there is pressure on the cauda equina, it can cause problems like sciatic pain, loss of feeling in the legs, drop foot, and sometimes bladder, bowel and genital issues, but it rarely causes paralysis. So if one has equally bad cervical and lumbar problems, cervical issues take priority over lumbar problems.

    How bad?? The spine specialist will correlate the findings of the MRI with what he/she finds upon physical exam, a basic neurological exam and after hearing your description of what impact the symptoms have on your daily life. Any time you see the word "severe" on the report, it is not good news! I would suggest you get a second opinion regardless of what the current neurosurgeon says. I would suggest a fellowship-trained orthopedic spine surgeon for that second opinion.

    You will find with the lumbar stenosis that your legs will continue to lose muscle mass and vitality until it will become very difficult to walk, regardless of whether there is pain.

     
    Old 07-19-2015, 06:21 PM   #3
    inspirations7
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    Re: New here - Confused about MRI

    Thank you so much, Teteri66, I need to know what I'm facing. I do so much better that way. I only gave the board the Cervical Impression; there was more on the lumbar one.

    Polyneuropathy was diagnosed about a year ago. Prior to that, it was peripheral neuropathy, diagnosed for maybe 10 years. I have other health issues, so I don't keep up with it. The polyneuropathy was diagnosed by my neurologist with nerve conduction tests and EMG. I was diagnosed with peripheral neuropathy by the head of neurology at Emory in Atlanta about 10 or so years ago. Also had nerve conduction tests.

    My last cervical MRI was about 6 or 8 years ago, and the lumbar before that. Like I say, I've had several health issues I've managed to keep in check, but I'm having difficulty keeping up with them, and remembering when, and who, I've seen about them.

    I am so glad that you told me straight forward what I may be facing, as this the best way for me to handle things. If the doctor told me these things, I'd go blank. I need to be prepared before hand.

    This is more serious than he was leading me to believe when I was in the office. He didn't seem to concerned about the lumbar. (He had the CDs of my MRIs.) No one would give me my cervical report initially. Both doctors seemed to beat around the bush. I finally called the neurologist's receptionist and asked her to fax it. She did. It took three weeks.

    I have other conditions that may impact what they may need to do. I'm concerned about those as well. Some have gone into remission, like Rheumatoid Arthritis. But I also have some asthma and a lot of adhesions too. And some other things.

    Question: Would the stenosis cause my toes to try to overlap? They haven't yet, but they are trying to.

    Again, thank you so much for giving me this information.

     
    Old 07-20-2015, 06:30 AM   #4
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    Re: New here - Confused about MRI

    As you know we are not doctors, just fellow fellow sufferers seeking and sharing information. There is always a possibility that I am wrong...so keep that in mind. I wouldn't want to scare you unnecessarily. Plus one never knows how a particular doctor will choose to share information. I just wanted to make clear that your issues are sufficiently significant that you should not ignore them.

    The reason I asked about the neuropathy is due to an experience I had. Five years before I had any idea I might have a back problem, my toes began tingling and occasionally the middle toes on my right foot would pull up and cramp. I was visiting my parents. When taking my mom to her podiatrist, I decided to make an appointment too. He diagnosed me with peripheral neuropathy. I returned home and eventually mentioned this to my doctor...where PN found its way onto my medical chart. Seven years later, after my first lumbar surgery when I was still having severe sciatic pain, I went to a pain management doctor who asked about the PN. I told him about the podiatrist and that I had never had an EMG. He ordered one, and it turned out that I did not have PN. What I had experienced had been the first symptoms of my spinal stenosis! It just took it five years to develop into something that affected my legs and lower back.

    I cannot speak with certainty about the toes trying to overlap. I assume in my feet that it has something to do with nerve damage, but I think the joints are also affected by some arthritis.

     
    Old 07-20-2015, 06:36 AM   #5
    inspirations7
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    Re: New here - Confused about MRI

    It has been such a long time since I've seen anyone for my back issues, I wonder what things I should and should not do given the state of my current MRIs. I have given up heavy lifting, vacuuming, that sort of thing. I did something stupid the other day and lifted a 24-bottle case of small water and tried to heave it under the basket. I lost my balance and hit the supermarket floor. Luckily, my body took the brunt of it, and my head merely glanced off the floor. And, luckily, no one saw me.

    I appreciate what you've said. I realize it's only an opinion, but it's far better than my imagination.

     
    Old 07-20-2015, 07:16 PM   #6
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    Re: New here - Confused about MRI

    Did you hear from the doctor today?

    You need to avoid any repetitious movement, avoid bending or twisting at the waist, reaching up overhead or to the side. You should avoid lifting anything heavy. Ask for groceries to be packed light, etc. after lumbar surgery, many doctors say toto lift anything heavier than a gallon of milk. Then it gradually goes up...

    I have only had lumbar issues so I have fewer tips for cervical issues. You just need to make a conscious effort to think before you move or do something.

    You definitely do not want to go to a chiropractor and massages are probably not a good idea until you see the spine specialist.

    Most housework is out, especially vacuuming, sweeping, raking.

    If you have access to a pool, the best exercise would be to walk in warm water.

     
    Old 07-21-2015, 05:49 AM   #7
    inspirations7
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    Re: New here - Confused about MRI

    No, I haven't heard from the doctor (neurosurgeon). It has been three weeks now. I'm 71, and though I am fairly active (I work from home), I wonder if being on Medicare has anything to do with the fact he's not contacting me. Initially, he told me after he'd talked to my doctor, he'd get back to me in two days. I do know that once I talked to his nurse last week, she had several people to call, including me. She told me he was still trying to get up with my neurologist. I don't want to have any surgery, as I'm not in any pain right now. For years, I had tons of pain (before epidurals), but that has all stopped. I'm afraid if I have surgery, I would again have the pain. I would just like to know what I'm facing ... You have been extremely helpful--a lifeline I needed. If you have any other thoughts, please let me know.

    No, I don't have access to a pool. My husband does a lot of the heavier things since I've had issues a while. But, this MRI is worse than the one several years before. I do twist and bend at the waist. I'll be more cognizant of this.

     
    Old 07-21-2015, 10:08 AM   #8
    teteri66
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    Re: New here - Confused about MRI

    Yes, I suspect that in addition to being busy, he needs to figure out what he wants to say to you, how to proceed. I would concur that if you are not in pain, you do not want to risk any spine surgery. It should always be a last resort.

    Keep calling the doctor's office from time to time just so your file doesn't go to the bottom of the stack! I think it helps to have a proper diagnosis so you know how to proceed in the future.

    Also, not to alarm you, but with severe issues in the cervical spine, it is a wise idea to have a specialist lined up. In the event that you develop an emergency, you will want to know who to call. If you are not considered a "new patient," it can take 6-8 weeks to get an appointment, and you do not want to take your chances at the emergency room.

    If you have more questions, I am happy to try to answer them. I didn't go into much detail about the MRI, but could if you have questions.

     
    Old 07-22-2015, 05:52 AM   #9
    inspirations7
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    Re: New here - Confused about MRI

    Hi Teteri66,

    I do have some questions. My cervical report was fairly long. I only gave you the impressions. If you could explain to me a little better some of these things so I would be aware and be prepared, I would greatly appreciate it:
    * I "appear" to have a large Schmorl node with some loss of signal.
    * Evidence of retrolisthesis of C4 on C5, C5 on C6, and C6 on C7.
    * Severe loss of disc space height and signal C4-5, C5-6, and C6-C7. Also, low signal there.
    * Some anterior cord compression on sagittal at C4-5, C5-6 and C6-7.
    *C-3 to C4 has central bulge effacing the subarachnoid space, no cord compression.
    *C4-C5 has large left lateral disc spur complex effacing the subarachnoid space, slight abutment against the cord.
    *C5-C6, there is diffuse disc effacing the subarachnoid space flattening and splaying of the cord. Another area has slight anterior flattening and splaying of the cord.
    *Moderate to severe left neural foraminal stenosis.
    *

     
    Old 07-22-2015, 07:46 AM   #10
    inspirations7
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    Re: New here - Confused about MRI

    I agree with what you said below, but I don't know where to start. Do I ask my neurologist for another doctor's name? Do I wait till I see the current doctor, and then say I want another opinion? Do I strike out on my own and get another doctor? Doing this last one has always worked out badly for me.
    Any thoughts? If you missed it, see the other questions I had.

    Thank you so much.


    <<Also, not to alarm you, but with severe issues in the cervical spine, it is a wise idea to have a specialist lined up. In the event that you develop an emergency, you will want to know who to call. If you are not considered a "new patient," it can take 6-8 weeks to get an appointment, and you do not want to take your chances at the emergency room.>>

    Last edited by Administrator; 07-22-2015 at 05:25 PM.

     
    Old 07-23-2015, 02:57 PM   #11
    teteri66
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    Re: New here - Confused about MRI

    I was in the process of writing a long de tailed answer to your questions, but got interrupted by dogs needing food, then husband wanting to eat, etc. In the interim I managed to lose the post. I will tackle it again later tonight.

    Doctors tend to refer to people in their own sphere...medical practice, hospital, etc. I guess first you need to see what providers are covered by your insurance as I think it quite likely you will end up with surgery.

    PTs are often a good source of information. They tend to know who the good spine docs are. If you live near a teaching hospital or univ. teaching hospital, you could pullout some names from there...but you have to make sure they primarily or only work on the spine. Then you can do some research online by typing the name of the doctor into a search engine. There are some national websites thatwillprovide basic info about the doctor...his education and training, etc. Some have reviews by patients. Also ask around among your friends and acquaintances. Seems like everyone knows someone who has had back surgery.
    Also, ask your family doc or PCP.

     
    Old 07-23-2015, 04:53 PM   #12
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    Re: New here - Confused about MRI

    The report indicates that there are a number of things wrong in the cervical spine, primarily from C3 to C7. They would all fit under the umbrella of degenerative disc disease. DDD is misnamed as it is not really a "disease," but a series of cascading events that begins with the beginnings of the degenerative process.

    Discs are the cushions between the bones of the spine (vertebrae). They are comprised of over 90% moisture but do not get their nourishment from vessels that run through them. Instead, they get nourishment from the vertebral endplates that rest along the top and bottom sides of the discs. As we age, and in the case of the spine, this process can begin in our 20s, the discs begin to dry out. If sufficient moisture is lost, the discs "pancake" or flatten, bring the bones of the spine closer together, even touching. This is referred to as a "loss of disc height."

    As the discs begin to lose height, it sets off a series of events . If the body senses this is causing some instability, the disc and surrounding facet joints can develop bone spurs. This only becomes a problem when these enlarge the joint or disc, and put pressure on the corresponding spinal nerve root.

    Another issue that an cause instability and can also affect a nerve is a spondylolisthesis. This describes when one vertebra slips over the top of the adjacent vertebra. When it slips off toward the back side, it is called a retrolisthesis...such as is noted at C4-C7.

    You will notice that several disc bulges are noted. In some cases, the bulge is pushing into the neural foramina. The foramina is an opening that allows the spinal nerve to exit thespineand go out to the part of the body it innervates.

     
    Old 07-23-2015, 05:26 PM   #13
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    Re: New here - Confused about MRI

    Continued....

    There are two primary spots where spinal nerves can end up compressed or irritated. One is in the central canal. The other is in the foramina. The foraminal openings are located at each pair of vertebrae. When either of these spots becomes narrowed, through a bulging disc, facet enlargement, etc. it can result in nerve compression the patient feels, either right at the spot in the back, or any place along the length of the nerve path.

    (This spinal stenosis tends to get worse as we age. Sometimes you will see an older adult walking through a store, leaning forward as the person pushes the shopping cart. This tends to relieve the pressure somewhat from the central canal stenosis.)

    The subarachnoid space is the compartment that contains the cerebral spinal fluid that surrounds the spinal cord. Sometimes a disc bulge will push into the side of this space...which means if the bulge enlarges, it can soon pinch the spinal cord. ...which can lead to all sorts of serious issues. You will see that you have a couple levels where there is pressure into the subarachnoid space,
    and,more seriously, cord compression at C4-C7.

    Radiologists use specific words to describe "how bad" an issue is...just to give someone some idea without looking at the films. These are: minimal, mild, moderate and severe.

    Finally "loss of signal" refers to how something shows up on MRI. When a disc loses moisture or dries out, it has a different appearance on the imaging, and since it does not appear as dense, the doctor knows it has a lower water content. This is referred to as "loss of signal."

    Hope this quick explanation helps you! You can do further research on degenerative disc disease, cervical cord compression and stenosis to learn more. Also, I always find it helpful to refer to spinal anatomy to see where all these terms are located...like the foramen.

     
    Old 07-24-2015, 05:27 AM   #14
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    Re: New here - Confused about MRI

    Teteri66,

    Thank you, thank you, thank you! I didn't mean for you to spend so much time, but I'm truly appreciative that you did. I'm trying to understand the gravity of what this report says (without trying to downplay it as I'm want to do sometimes). It's easier to ignore my problems, even if they don't go away. Right now, I need to understand that this is fairly serious, and I need to get some answers. Since I'm not getting any response from the neurosurgeon (who, by the way, made me sign that I would only go to arbitration if there are any issues following surgery), I think I'll contact my neurologist. Is that wise? I don't like to go over anyone's head in a situation like this, but I need to know what to do and what not to do. And what exactly are my issues--from the doctor's mouth, etc.

    Again, bless you for helping me. I so appreciate it.

     
    Old 07-24-2015, 09:48 AM   #15
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    Re: New here - Confused about MRI

    The way I see it is that you have cord compression in a couple areas and the other discs' issues indicate they are headed in that way. If you trust your neurologist, it may be a good idea to ask his opinion...see if he can give you the name of a fellowship-trained orthopedic SPINE surgeon as well as a neurosurgeon. These two specialties receive similar training but sometimes approach problems from a slightly different angle.

    I do not understand the part about the neurosurgeon demanding you sign something....is this a workman's comp case? I have never heard of that!

     
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