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  • MRI of cervical spine

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    Old 09-27-2017, 04:03 PM   #1
    MarleneS
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    MRI of cervical spine

    Hi, I have an appointment with a neurosurgeon on Tuesday but am trying to educate myself before the appointment. Reading that I have a disc extrusion is scary. Thoughts on these results? Also, I'm having tingling in my arms and hands which is why it was ordered, but I'm also having pins & needles in my legs, can your cervical spine affect your legs? Thank you.

    Alignment: Straightening of the normal cervical lordosis. Alignment is anatomic.

    Craniocervical junction: Craniocervical junction is normal.

    Cord: Left ventral cord is mildly flattened by disc extrusion at C5-C6. Disc may contact the cord at C4-C5. No evidence of cord edema.

    Bone marrow signal/fracture: No evidence of pathologic marrow infiltration. No evidence of prior fracture.

    Cervical soft tissues: The paraspinal soft tissues are within normal limits.

    Disc dessication throughout the imaged spine.

    C2-C3: Canal and foramina are patent.

    C3-C4: Disc osteophyte complex with mild canal stenosis. Facet and uncovertebral hypertrophy with mild left foraminal narrowing.

    C4-C5: Disc osteophyte complex with mild to moderate canal stenosis. Facet and uncovertebral hypertrophy with mild bilateral foraminal narrowing.

    C5-C6: Disc osteophyte complex with superimposed left central disc extrusion that extends inferiorly and minimally flattens the left ventral cord. There is CSF dorsal to the cord. Moderate canal stenosis. Facet and uncovertebral hypertrophy with mild right foraminal narrowing. Left foramen is patent.

    C6-C7: Disc osteophyte complex greater on the left mildly to moderately narrows the canal. Foramina is patent.

     
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    Old 09-28-2017, 08:28 AM   #2
    teteri66
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    Re: MRI of cervical spine

    Welcome to the board. Usually we think of the cervical spine causing problems in the arms, hands, neck and shoulders, and lumbar spinal issues causing problems in legs and feet. While as a general rule, this is true, the exception is when the central canal/spinal cord are impacted...as is the case with you at C5-6 and possibly at C4-5.

    When there is compression of the spinal cord, the impact can be felt at the site or anywhere below the level (not above!). So you could have a disc pushing into the cervical spine that causes heaviness or tingling in the legs, but a disc pushing into the lumbar spine could not cause numbness in a hand or arm.

    First let's define a few terms as I don't know your level of knowledge as it relates to the spine! " Disc osteophyte complex" develops when a series of bone spurs develop on multiple vertebrae, compressing the intervertebral discs and exerting pressure on the nerve roots or even the spinal cord. This is a part of a degenerative process sometimes "degenerative disc disease."

    DDD often begins when the disc begins to dry out. The intervertebral disc is the soft cushion that sits between the vertebrae (bones) of the spine, separating the bones one from another and allowing some movement in the spine. They are comprised of more than 90% moisture and yet, do not have their own source of hydration. So as we age, just through normal daily living , discs tend to dry out.
    (Desiccate).

    When discs dry out, it causes the disc space to narrow, which brings the bones together. Sometimes this space loss is so severe that the bones can actually fuse together naturally. Or, a nerve can get a bit pinched if in the way.

    As the space narrows, the body naturally tries to help out by throwing down more bone in an attempt to stabilize the spinal segment. This results in bone spurs (osteophytes) which can form along the disc and adjoining facet joint.

    This often results in the facet joint becoming enlarged...which causes problems because now things are not fitting nicely into the already compact space! The result of all this enlargement is often nerve compression and a process called "stenosis."

    Stenosis means narrowing and it usually occurs in two places in the spine--the central canal (that contains the spinal cord) and in the neural foramina, which are openings located at each vertebral level where a spinal nerve exits the spine and goes out to innervate a specific area of the body.

    When a foraminal opening becomes blocked by an issue like a disc bulge, enlarged facet joint, bone spurs, etc. the spinal nerve at that level tens to become irritated or compressed. As mentioned above, pain and symptoms like tingling, heaviness, numbness can be felt right there or anywhere along the path of that nerve. If interested, to see what is innervated along the pathway of C4, C5 and C6 spinal nerves look online for a "dermatome map."

    One other term to know is uncovertable hypertrophy... which refers to degenerative arthritic changes in the joints which results in bone spurs...which can cause severe foraminal stenosis. You will note words like mild or moderate...radiologists use specific words as a type of ranking to evaluate in a general way just "how bad" or "how much" an issue is thought to be. These are: minimal, mild, moderate and severe. You will see that much of your foraminal stenosis is thought to be "mild." Ofte issues do not need to be addressed until they become severe...occasionally moderate.

    The segment of concern is at C5-6 where the disc extruded. This means that disc material is coming out from the disc toward the left side and pushing over toward the central canal where it is slightly causing some flattening to the spinal cord and a little displacement of spinal fluid resulting in moderate spinal stenosis.

    The left foramina at this level is open--no stenosis, but there is a small amount of stenosis in the right foramen caused by the joint arthritis.

    All the other cervical discs show some amount of disc desiccation.

    While this sounds scary, it is possible that it may be able to heal without surgical intervention. Most people over about age 30 show some level of degenerative disc disease and disc desiccation, which is a part of DDD.

    With conservative care, it may be possible for the disc to heal and for the disc material to reabsorb back into the body. This would move it away from the thecal sac and remove the spinal cord flattening...which should resolve the nerve pain, tingling, etc.

    Please come back to tell us what the neurosurgeon has to say! If surgery is recommended I always recommend getting more than one opinion...with an orthopedic spine surgeon and a neurosurgeon.

     
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