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  • Need help with understanding X-RAY/MRI

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    Old 11-13-2016, 04:49 AM   #1
    lise2016
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    Need help with understanding X-RAY/MRI

    Hi everyone,

    This is my first post here and would like help understanding my cervical X-RAY and MRI. I am a 56 year old female and started having problems about six months ago. This was when my Primary Physician told me it was mild Osteoarthritis. He advised X-RAYS and general pain management. Found a PM Clinic and the Doctor there told me that I didn't need the MRI that was advised by the radiologist...

    Got a second opinion and here are the results from both cervical X-RAY/MRI:


    XRAY FINDINGS: There is straightening of the normal cervical lordosis. Vertebral body alignment and stature are normal. The odontoid and the C1-C2 articulation are unremarkable. There is disc space narrowing at C4-C5 and C5-C6. There is mild sclerosis of the C5 vertebral body. There are marginal osteophytes involving C4, C5 and C6. There appears to be a perched facet joint at C6-C7 No fracture, subluxation, or bone erosion is seen. The right neural foramina demonstrates narrowing at C5-C6 and C7-T1. The left neural foramina demonstrates narrowing C5-C6 and C7-T1. The prevertebral soft tissues are normal. Bony structures are normal in density.

    IMPRESSION: Possible perched facet joint at C6-C7. Follow-up recommended, CT or MRI of the cervical spine.
    Findings suggestive of muscle spasm.
    Degenerative disc disease at C5 and C5-C6.
    Modest cervical spondylosis.
    Bilateral normal [neural] foraminal stenosis at C5-C6 and C7-T1.


    MRI FINDINGS:
    General Observations: Straightening of cervical lordosis. Vertebral body height and alignment otherwise maintained. Mild reactive endplate changes at C5-6. Bone marrow signal otherwise unremarkable. Disc desiccation and height loss at C5-6. Remaining disc heights are maintained. No abnormality at the craniocervical junction, and the visualized posterior fossa and skull base are normal. Spinal Cord: Normal caliber, contour and signal intensity.

    C5-6: Broad disc bulge and ligamentum flavum hypertrophy cause mild to moderate central stenosis with mild flattening of the spinal cord but no cord signal abnormality. Uncovertebral hypertrophy and facet arthropathy cause moderate to severe left and moderate right neuroforaminal narrowing. Possible impingement on the exiting left greater than right C6 nerve roots.
    C6-7: Small disc bulge without significant central stenosis or neuroforaminal narrowing.


    IMPRESSION:
    Degenerative changes of the cervical spine most prominent at C5-6, where there is mild to moderate central stenosis with flattening of the spinal cord but no cord signal abnormality. Moderate to severe left and moderate right neuroforaminal narrowing at this level with possible impingement on the exiting left greater than right C6 nerve roots. No other convincing evidence of nerve root or spinal cord impingement.

    What bothers me is the flattening of the spinal cord and the cord impingment. How bad is it? I am in constant pain (dull ache), primarily in the upper back and have tingling/numbness in my hands and feet. There's stabbing pain in my back sometimes as well as not able to hold onto objects by hand the last few weeks.

    Also, a very strange noise comes from my throat that sounds like I am struggling to breathe, occasionally.
    I was diagnosed with vertigo in 2013, now thinking it could possibly be the spinal cord.

    Last edited by lise2016; 11-13-2016 at 10:53 AM. Reason: Additional information and revision.

     
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    Old 11-14-2016, 07:37 AM   #2
    teteri66
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    Re: Need help with understanding X-RAY/MRI

    Welcome to the board. Don't you love it when your doctor has a crystal ball and is able to diagnose a spinal issue without any imaging to guide him? To avoid wasting a lot more time, I suggest you consult with a spine specialist for an accurate reading of your MRI, diagnosis and plan of treatment. This can be either a fellowship-trained orthopedic spine or neuro surgeon. Just be sure the doctor's practice is limited to issues of the back and neck. Many do not require a referral from your PCP or family doctor.

    You are right to be concerned about the possibility of cord impingement. This is another reason why it is a good idea to consult with a spine specialist. At this point, there is no cord damage, but it will be good to have a base line MRI and to have your foot in the door with a spine specialist as you will want to keep an eye on this. As with any medical problem that has the potential to become serious, it is much better when it is caught early before permanent damage is done.

    Since I gather you are just beginning down this road of spinal issues I highly recommend that you do some reading and acquaint yourself with basic information about the spine. This will help you have a conversation with the spine doctor and be able to better understand what the doctor says to you.

    There are some wonderful sites online that excellent diagrams of spinal anatomy, and specifically, look up ".degenerative disc disease. ". You will see that this is a group of events that often happen in the spine as the spine begins to age...

    The intervertebral discs, the cushions between the bones of the spine, are comprised of more than 90% "water," and they tend to lose moisture as we age. In the human spine, this aging process begins in our twenties! Obviously some age more quickly than others, some people abuse their backs more than others...so "wear and tear" is different for everyone.

    When the discs begin to age...to bulge or herniate or rupture, a series of events are set into action. As the disc loses moisture, the process is called "desiccation." This causes the disc to flatten, which brings the vertebrae closer together, narorowing the disc space. Often this causes some changes to the vertebrae that adjoin the degenerating disc. The endplate is the part of the bone that rests against the disc and is what provides nourishment and moisture to the disc.

    In the "general observations" section of the report you will see the overall condition of the cervical spine. There is a slight loss of the natural curve of the cervical spine. Disc space height is maintained at almost all levels with the exception of C5-6...which is the "problem" segment. Basically everything is "normal" with the exception of this segment. This includes the status of the spinal cord which is normal in all ways.

    At C5-6 the disc is bulging and is described as broad based, which means it occurs over the central part...(neither left or right side specifically). This bulge and the hardening of the adjoining ligament are pushing out of the disc space over toward the area of the spinal cord. Since the area of the neck is so small and everything is packed into a small space, when any one part increases in size or grows out of its assigned space, problems can occur. In this case, the disc pushes into the spinal canal, causing it to become narrower than usual. This is causing the spinal cord to flatten but it is not enough to keep the cord from functioning normally.

    In addition, the facet joints are showing signs of arthritic change and are enlarging which is causing a narrowing of the foramina at this level. These are the openings located at each segment where the spinal nerve exits from the spine and goes out to the part of the body that the spinal nerve innervates...in this case it is the C6 spinal nerve that is being affected. This narrowing process that can occur in the foramina and in the central canal is called "stenosis."
    In this case it is judged to be moderate to severe on the right side and moderate on the left. This is based on a ratings that uses the following words to describe "how bad" something is: minimal, mild, moderate and severe. The fact that yours is thought to be severe means the spinal nerve is being compressed to a great extent and would most likely be causing symptoms that radiate out from the back. ( to see where you can look online for a dermatome map....this will show which area of the body is innervated by which spinal nerve....).

    At C6-7 there is a small disc bulge but it is not causing any stenosis in the foramina or central canal.

    Since there is no cord impingement, it is likely that a spine specialist will recommend a course of conservative treatments for your issues.

    Good luck to you.

     
    Old 11-14-2016, 12:30 PM   #3
    lise2016
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    Re: Need help with understanding X-RAY/MRI

    Thank you so much! I have been worried since the MRI came back, but I still have two questions. (1) What is the difference between compression and impingement? Also, since the spinal nerve is being compressed a great deal, will conservative treatment work with this?

    Last edited by lise2016; 11-14-2016 at 12:32 PM. Reason: editing

     
    Old 11-15-2016, 09:50 AM   #4
    teteri66
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    Re: Need help with understanding X-RAY/MRI

    I think the terms are used pretty much interchangeably. Think of it as there being direct pressure on something...i.e., a nerve or the spinal cord.

    It is difficult to tell without trying whether conservative treatment will help or not. I had severe stenosis of the central canal and there was nothing that would have helped other than surgically cleaning out the "gunk" and opening up the canal. They can cut away things like bone spurs, shave down enlarged joints, remove any scar tissue, etc. to make more room and to try to restore the opening....you may need to have something similar done to free up the C6 spinal nerve.

     
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    lise2016 (11-15-2016)
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