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  • FINALLY, MRI RESULTS - Can you guys give me some input?

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    Old 11-08-2007, 12:31 PM   #1
    poopoopadoop
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    Red face FINALLY, MRI RESULTS - Can you guys give me some input?

    Hi, Everyone,
    As you may know from my previous post, I have been suffering for 4 days after reinjuring my neck 6 months after ACDF C5-6. Here are my MRI findings:

    (I am just giving you the important stuff).

    C2-3, C3-4 - fine

    At the C4-5 level, mild concentric ridge and annular disc bulge abut the ventral portion of the cervical spinal cord. There is a small left paracentral-lateral disc herniation which also abuts the left ventral portion of the cervical spinal cord. The spinal canal is moderately stenotic.

    At the C5-6 level (WHERE I HAD ACDF IN 4/07), moderate concentric posterior ridge abuts the ventral portion of the cervical spinal cord. The spinal canal is moderately stenotic.

    At the C6-7 level, a small right paracentral-lateral disc herniation which also abuts the ventral portion of the cervical spinal cord. The spinal canal is moderately stenotic.

    Postcontrast imaging sequence demonstrates degenerative, superimposed upon, postoperative marrow enhancement at the C5-6 level. ?????

    IMPRESSION:
    Status post ACDF at C5-6 with postoperative changes as described above. Spinal stenosis from C4-5 through C6-7, secondary to a combination of congenital and acquired spinal stenosis.

    Small disc herniations at C4-5 and C6-7.

    ** So, I am in excruciation pain. Please tell me what you think. What treatment do you think the neurosurgeon (my appt is next week) will recommend? Do you think I am a candidate for surgery? If not, what other treatment?

    Thanks so much!
    Lisa

     
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    Old 11-08-2007, 12:36 PM   #2
    meeshalu
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Well, I had the same type of thing with only one disc at the bottom of my spine. They said surgery is the only thing that will correct the protrusion of the cord. Hope that helps a little.

     
    Old 11-08-2007, 06:44 PM   #3
    poopoopadoop
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Thanks for your post.

    Any other opinions/thoughts from others?
    (Sorry just desperate)... - Lisa

     
    Old 11-09-2007, 01:43 PM   #4
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Sorry you don't feel well. It hasn't been a year so I don't think surgery is something that would be recommended (and although I am not a dr., I don't see anything that they would want to proceed with in an emergency). The good news is nothing about screws or plates being loose. It looks like you have degenerative changes of arthritis growing, common for people who have had these problems. Sometimes these can be sped up after a surgery but I looked at your original MRI results you posted and some of these things were present at that point before your first surgery. I am curious why the surgeon chose to only do the one level at that time? Was this discussed?

    I am guessing you may have torqued your neck and maybe caused a little inflammation in there. You have some standing issues that would be sensitive to re-injury. Kind of like when people get whiplash. What I do think they will recommend is some conservative treatment and rest. Maybe an injection might help flush out inflammatory cells. Or possibly a course of prednisone.

    other advice for you, it appears to me that you have degenerative changes that are probably lifetime for you. Surgery can't stop all degernative processes. Being active is good, but you might need to be more selective about the best long term activities for you. Sometimes surgeons lump us all together, there are so many people with bad MRIs walking around and have no symptoms. Then there are those that have tons of symptoms. Your particular make up might be sensitive to injury, so now that you have had spine issues you might want to be extra protective of yourself. I know doc released you, but this is an example of how delicate the balance is for our cases!

    I will hope for improvement for you.

     
    Old 11-09-2007, 02:11 PM   #5
    poopoopadoop
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Hi, Neckpatient,
    Thanks so much for all the information and your take on this. I agree with everything you said. At the time of my single level ACDF (c5-6), both surgeons who I consulted did not recommend a double or triple ACDF. I looked back at my MRI from 2/07 and saw that I did not have any herniations at C4-5 or C6-7 back then. Now I have a "small" disc herniation and moderate stenosis at both C4-5 and C6-7. I know surgery is not routinely recommended for small herniations. I am not looking to rush into another surgery, I am merely frustrated by the pain. I am fairly certain that I am in for another surgery or surgeries down the line, as I realize this is progressive.

    So, if the surgeon did not recommend surgery, the idea is to just make me more comfortable until the day comes when the disc herniates more or the stenosis worsens and I 'need' surgery? Is it just like buying time? It's not like my spine will heal itself since my condition (stenosis and multiple disc herniations) are progressive.

    Thanks again,
    Lisa (a fellow neckpatient)

     
    Old 11-10-2007, 10:55 AM   #6
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    hi fellow neckpatient,
    I don't think I explained it fully. I looked at your post from March, 2007 of your fisrt MRI. It says you did have an annular bulges at C4-5 and C6-7. This was the start of your herniations.

    Discs have a rigid outside rim, but are soft and gel-like inside. Activity, stress, or a mechanical problems can cause the discs to bulge. A disc becomes herniated when it degenerates to the point that the gelatin within the disc protrudes outward. A herniated disc also may result from injuries to the spine, which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments. Pain occurs if this material extrudes or bulges far enough to press against a nerve root. When you have bulges that do not resolve, they are prime candidates for herniations. Especially the dynamics of fusion surgery add additional stress to the spine. The spine is not intended to be fused. when it is necessary to fuse, this does cause pressure on the entire spine.

    Another thing is when you have this disc material bulging out and herniating, the gel material isn't intended to be in the canal or around nerve roots. Although injury to the outer covering (capsule or annulus) of a disc can cause pain, often a herniated disc does not cause any pain. Pain occurs when the membrane on the outside of the spinal cord or spinal nerves is irritated. The spine starts working to contain and stabilize the spine. Bone spurs (osteophytes) and scar tissue start growing to help "protect" the spine. It kind of starts off this whole process. You had all the components there.

    Often a herniated disc heals on its own as the jellylike material inside the disc (nucleus) is broken down and absorbed by the body, a process called resorption. This can take 1 -6 months.

    This time around I would include an opinion from an orthopedic surgeon. THe Neuros will pay attention to certain things, the ortho will look at others.

    Try to really follow the conservative rest instructions and see if your body can take care of this problem. A second surgery will be more complicated. They will have to pull out your existing plate, scar tissue etc. There is higher chance of not resolving all your pain the second time around.

    Your stenosis might grow at a slow enough rate that if this problem resolves you might not need any further surgical intervention in your future. But most definitely you need to take care of yourself.

     
    Old 11-10-2007, 11:24 AM   #7
    poopoopadoop
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Thanks, Neck. That is very helpful. So what you are saying is that I should just follow conservative measures, ie, rest, PT perhaps, pain management (either oral or things like nerve blocks if recommended) and wait for the reabsorbtion to take place. I can't even imagine that happening, but I take your word for it. I realize that those discs pre-surgery were not good, bulging. I really wonder what the neurosurgeon will say this week. I have a feeling he won't want to rush in there either. I imagine though at some point I will be facing more surgery.

    Oh, also, I DO have new numbness in my middle and pointer finger - I never had that before. Does that matter in my decisionmaking? My fingers also feel cold to me. I remember I had that before my last surgery.

    Thanks again - I know you really know what you are talking about. It is amazing what 'experts' we become. I have been staying up researching so much on these things, even teaching myself to interpret MRIs.

    Take care,
    Lisa

    ps = how are you doing these days?


    Quote:
    Originally Posted by neckpatient View Post
    hi fellow neckpatient,
    I don't think I explained it fully. I looked at your post from March, 2007 of your fisrt MRI. It says you did have an annular bulges at C4-5 and C6-7. This was the start of your herniations.

    Discs have a rigid outside rim, but are soft and gel-like inside. Activity, stress, or a mechanical problems can cause the discs to bulge. A disc becomes herniated when it degenerates to the point that the gelatin within the disc protrudes outward. A herniated disc also may result from injuries to the spine, which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments. Pain occurs if this material extrudes or bulges far enough to press against a nerve root. When you have bulges that do not resolve, they are prime candidates for herniations. Especially the dynamics of fusion surgery add additional stress to the spine. The spine is not intended to be fused. when it is necessary to fuse, this does cause pressure on the entire spine.

    Another thing is when you have this disc material bulging out and herniating, the gel material isn't intended to be in the canal or around nerve roots. Although injury to the outer covering (capsule or annulus) of a disc can cause pain, often a herniated disc does not cause any pain. Pain occurs when the membrane on the outside of the spinal cord or spinal nerves is irritated. The spine starts working to contain and stabilize the spine. Bone spurs (osteophytes) and scar tissue start growing to help "protect" the spine. It kind of starts off this whole process. You had all the components there.

    Often a herniated disc heals on its own as the jellylike material inside the disc (nucleus) is broken down and absorbed by the body, a process called resorption. This can take 1 -6 months.

    This time around I would include an opinion from an orthopedic surgeon. THe Neuros will pay attention to certain things, the ortho will look at others.

    Try to really follow the conservative rest instructions and see if your body can take care of this problem. A second surgery will be more complicated. They will have to pull out your existing plate, scar tissue etc. There is higher chance of not resolving all your pain the second time around.

    Your stenosis might grow at a slow enough rate that if this problem resolves you might not need any further surgical intervention in your future. But most definitely you need to take care of yourself.

     
    Old 11-11-2007, 11:18 AM   #8
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    Re: FINALLY, MRI RESULTS - Can you guys give me some input?

    Of course we are just relying on this immediate reading and what you think you see on the film. It will be interesting to see what the doc says.

    It is not certain that your herniation will resolve itself, but it is worth the waiting to see if that is what they recommend. That numbness might be nothing significant it depends on how severe it is. If you pass the pin ***** test, but still "feel" it is numb it probably won't be a major concern to the doc. I have this permanent "feeling" of numbness in my middle finger (I think that is C5) but it really isn't numb.

    Not sure about cold hands, that could be lots of things from your neck to your metabolism etc.. I think you say you play tennis, it could also be a swelling or compression in the scalenes. Those same nerves pass through a little groove there as they go to your extremities. There is this thing called Thoracic Outlet Syndrome that can be what they call "functional". It gets caused by guarding, poor posture, and other activities. It can also cause cold hands.

    I have studied for the past three years because I keep looking for some solution to ask the dr. trying to find a way to get better. For me, I am the same - I manage daily I am not going to have any more surgeries. They just pile on top of each other, each causing more osteophytes and scar tissue. I would only do it again if I have a bad compression. I am defintely not looking forward to cold weather.

     
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