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  • Advanced degenerative disc disease: spinal cord involved?

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    Old 08-21-2016, 05:26 PM   #1
    Plates
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    Arrow Advanced degenerative disc disease: spinal cord involved?

    I see a neurosurgeon soon, but wanted to know if anyone had a similar DX and how you felt after surgery? I go from hopeful for a cure for this chronic pain to terrified of having spinal neck surgery! That I might be worse off.

    I don't really understand much about the MRI findings. Does this mean the spinal cord is involved?

    here is what the MRI showed:
    Impression:
    1. Advanced degenerative disc disease at c5-6 and c 6-7
    2. Posterior disc osteophyte complexes efface the ventral aspect of the thecal sac at both levels, but c5-6 slightly more so than c6-7. Significant narrowing of the canal. AP diameter of the canal is 6 mm at c5-6. CSF signal is effaced. No abnormal signal within the cord.
    3. Facet arthropathy in the lower cervical spine. This finding in conjunction with the degenerative disc disease results in at least moderate, if not severe, bilateral neural foraminifera narrowing at c5-6 and c6-7. Lesser narrowing on left side at c3-4.

    47 years old. I have had chronic pain as long as I can remember. Doctors blamed my weight and said I was too young to have arthritis. Over the years, I could barely stand or walk long from the severe pain. I did less and less, today I do hardly anything. I go to dr, PT, Chiro, deep tissue massages, groceries as quickly as I can and come home to lay down again. I do the bare minimum. I never asked for pain pills, just for a DX and cure. 2 years ago, things got worse. I couldn't even sleep from the pain...that was new. I begged doctors for relief and I would get 10 pills and a referral. I lost the excess weight years ago and I was still in pain. The MRI I just had done shows there is a problem, but still the Drs won't prescribe more than muscle relaxer (never helps) and tramadol (doesn't help any). I finally got the MRI as I was having more trouble walking. Now I have a referral to a neurosurgeon. I had a MRI on my left hip and pelvis but I was told it was basically normal so it was all be from my neck. I haven't seen that MRI report yet.

    Has anyone had a similar neck issue and had surgery for it? Thank you!

     
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    Old 08-22-2016, 08:14 AM   #2
    teteri66
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    Re: Advanced degenerative disc disease: spinal cord involved?

    Welcome to the board. I am happy to hear you will be seeing a neurosurgeon. If surgery is recommended, be sure to get at least one more opinion before proceeding...and it is often a good idea to get an opinion from a fellowship-trained orthopedic spine surgeon as well as a neurosurgeon. The two specialties have similar training but sometimes approach an issue slightly differently.

    Two more things to keep in mind: people on the board do not have formal medical training...i.e., we are not physicians. Second, the MRI is just one piece of the diagnostic puzzle. The spine specialist (the neuro or ortho spine surgeon) will correlate the MRI results to what is found in the physical exam and a basic neurological exam, as well as by what the patient reports is the impact of these symptoms on his/her daily living.

    It does not appear that you have spinal cord involvement yet, but there is loss of diameter of the spinal canal, which contains the cord and the spinal fluid. When anything pushes into the spinal canal or impacts it, there is a risk of nerve compression.

    Degenerative disc disease is not a disease per se but is a collection of symptoms caused by daily living/wear and tear. It usually involves several components of the spine that all work together to form the body's structural alignment. To be very basic...In each spinal segment, there is bone called the vertebra that is separated from the next vertebra by the intervertebral disc, which we usually just call a disc. The disc is comprised of mostly "water" and as we age, it tends to lose some of this moisture. This causes the disc to flatten or lose height, which brings the bones closer together. Connecting these bones is a synovial joint called the facet joint. It, along with the disc, is what allows us to bend and twist. As the disc beings to show signs of aging, and in humans this aging process begins in our late 20s, it can set off what amounts to a cascade of changes. Often the facet joints develop a bit of arthritis and begin to enlarge. As the disc flattens and the disc space begins to narrow, the body begins to lay down more bone in an attempt to stabilize this segment of the spine. This causes the joint to enlarge...which ends up creating a space issue...which ends up causing spinal nerve irritation or compression.

    So--disc osteophyte complex is a name for the process of growing this little bone spurs that cause what amounts to a space problem! There is too much "gunk," as my surgeon calls it, taking up valuable space that is needed by the nerves to function normally. In your case, these bony growths are pushing out toward the central canal where they are coming in contact with the canal and pushing in the side to the extent that it is affecting the diameter of the canal, narrowing it to 6mm. (Normal is 12-14mm in the lower cervical spine). Anything below 10mm is considered "stenotic." Usually there is an impact on the cord with this much narrowing, but that doesn't appear to be happening here. ("No abnormal signal within the cord.")

    Stenosis means narrowing. This occurs primarily in two locations in the spine: the central canal and in the neural foramina ( these are openings located at each vertebral level through which an individual spinal nerves passes as it exits the spine and goes out to a specific area of the body...for example the C6 nerve runs from the central canal across the top of the shoulder, down the inside of the arm to the thumb. C7 innervates the first two fingers fingers and C8 innervates the third finger and the "pinkie" finger.)

    3. Facet arthropathy refers to arthritis in the facet joints and is identified in the joints of the lower cervical spine. Remember, this causes the joints to enlarge. So this enlargement along with the DDD is causing stenosis or narrowing of the foramina at C5-6 and C6-7 that is judged to be moderate or severe on both the left and right side. To a lesser degree there is foraminal stenosis at C3-4 on the left side.

    Radiologists use specific adjectives to rate "how bad" an issue is. They are minimal, mild, moderate and severe. Severe in the case of stenosis means that the opening is mostly blocked, making it very difficult for the nerve to function properly.

    One other helpful piece of information can be found if you look online for a "dermatome map" as it will show which nerve innervates which part of the body.

    Have you had a lumbar spine MRI? Without spinal cord disease or compression, one should not have leg and hip pain, pain when walking etc. from cervical spinal nerve compression. These issues are usually caused by lumbar nerve compression and lumbar stenosis unless there is cord damage.

     
    Old 08-22-2016, 08:27 AM   #3
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    Re: Advanced degenerative disc disease: spinal cord involved?

    Thank you for the reply. Yes, I had an MRI of my left hip and pelvis, but I was told it was normal. I'm having severe pain walking walking more than 10 minutes. Short distances I'm fine. I'm feeling the pain in my left hip. Both legs are feeling heavy.

    Thank you again. I am impatient to hear from the neurosurgeon and get an explanation of the neck MRI so I posted here.

     
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