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  • MRI Results..Neck and Arm pain is driving me crazy!

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    Old 04-22-2008, 05:30 PM   #1
    tamlis
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    MRI Results..Neck and Arm pain is driving me crazy!

    Last year I had a cervical spinal fusion at C5-6 but continue to have neck and arm pain that just won't stop. So I had a new MRI a few weeks ago and here are the results. Can someone please help me understand these ? I see the doctor again Thursday and would like to know what kind of questions to ask him.

    Thanks bunches.

    At C3-4, disc dessication with mild annular disc bulge is noted, producing a 2 mm compression on the anterior thecal sac. There is near effacement of the fluid interface between the disc bulge and the spinal cord. There is no significant foraminal encroachment at this level.

    At C4-5, disc desiccation and a mild disc bulge/protrusion are also noted, extending into the right neuroforamen. A disc protrusion is prominent in the left paracentral region and produces a 2-3 mm compression on the right anterior thecal sac. Right anterior foraminal encroachment due to the lateralization of the disc protrusion is evident at this level. There is near effacement between the disk protrusion and the spinal cord.

    At C6-7, disc dessication with mild broad based disc protrusion is also present, producing a 2 mm compression on the anterior thecal sac, extending into both neuroforamina. Mild facet degenerative arthropathy is evident at this level. There is a 1 mm fluid interface between the disc protrusion and the spinal cord.


    Thanks again

     
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    Old 04-22-2008, 10:15 PM   #2
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    I am guessing your forearm has pain and burning - also along the outside of your arm, other pain too - could go even to the wrist?
    1. Disc dessication is disc drying. That results in loss of height and loss of cushion between your vertebrae. Dessication is commonly seen with other spinal degenerative changes. This will causes rubbing, wear and tear and a propensity to disc bulges as the disc weakens.
    2. Disc bulges - think like a marshmallow when you squeeze it. When they use this term it means there isn't any herniation or protrusion of the inner disk material.
    3. Thecal sac surrounds the cord and some of the nerves and also contains the spinal fluid. Usually doctors do not like to see compression and want to address this.
    4. The neuroforamens are like tiny canals where the nerve roots leave the spinal cord and pass through. Usually compression in the foramens causes arm/hand pain.
    5. Arthropathy in the facets: The facet joints and disc space form a joint complex near each vertebrae. Facet joint has two bony surfaces with cartilage between them and ligaments surrounding it. Synovial fluid lubricates the joints as is the case with any joint. Arthropathy is arthritic changes and it can cause pain. Usually seen in people that have disc problems.


    If I were you I would basically be asking the doctor to advise you what the most critical things are in his view, what treatment plan he is recommending. Then come back and we will help you decipher what he said. I am guessing he may recommend some kind of revision to your fusion - extending the levels. This will not guarantee that you will be pain free, but it will help shore up your spine and try to prevent further deterioration. Because your discs are bulging and spreading - this could get worse, even by little movements you could herniate and cause worse pain. It seems you have some widespread degeneration going on. I too have these problems and have been fused C4-7. If he is saying you need another surgery, you could ask him what happens if you do not do surgery. What other surgery option did he rule out and why. If you have no neurological symptoms/signs, your doctor may want to put you into pain management, PT, and a "watchful waiting" mode.

    Can't tell if your bulges are large, because it is really specific to your anatomy, in one person 1mm is large when in another 3mm isn't. Most likely it is significant to your spine because of the pain you are having.

    Good luck - I'll watch for your additional posts.

     
    Old 04-23-2008, 08:04 AM   #3
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    Thanks so much for your help neckpatient

    Yes, I have pain all the way down my arm like a burning, aching, pinching pain thats there constantly. Sometimes its shooting, sharp pain. My neck and shoulders are painfully stiff and ache bad. I had pain originally in my left arm with the first disk, but now its extended into my right arm, as well. The thing is Im having pain in my thoracic area, too. He knows I have thoracic pain too, but insisted on doing the cervical MRI first.

    Thanks for giving me direction on questions to ask. I dread surgery again, but this pain is driving me nuts! I feel worse than I did before surgery in many ways.
    Anyway, again thanks for the help and I will keep you informed.

    P.S. Do you know what the difference between a MRI with contrast and one without is? Also what does "effacement" mean?Thanks again.

    Last edited by tamlis; 04-23-2008 at 08:05 AM.

     
    Old 04-23-2008, 05:43 PM   #4
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    I too have symptoms nearly 2 years after my ACDF. As a result I am having a cervical posterior foraminotomy on 05/22. The CT Myelogram and EMG showed continuing nerve impingement.
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    Old 04-23-2008, 07:55 PM   #5
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    Hi tamlis - effacement is thinning. that means the thecal sac is thinning and that allows the cord to be touched or compressed. The MRI with contrast is given by using an IV or sometimes oral medicine. Contrast medication helps the tissues stand out more clearly on the MRI images.

    It is pretty common for cervical patients to also have thoracic symptoms. By chance do you have pain down your side chest or under your armpit?

     
    Old 04-24-2008, 08:31 AM   #6
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    My thoracic pain feels like a stiffness and painful aching pain similar to my neck pain. Sometimes it escalates when I do some little thing into feeling like someone hit me in the back with a sledgehammer with the pain running over to my rib under my breast and up towards my neck. I feel like I can't breath well and I can't move except very carefully. Sometimes this will last for days and then it will subside a little to the stiffness and aching pain. All I can do is be still and take pain pills every 4-6 hours.

    What can they really do if you have a herniated disk in your thoracic region? Can it get worse? (I can't imagine)

     
    Old 04-24-2008, 10:28 AM   #7
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    Although they can happen - herniated discs in thoracic are more uncommon because there isn't a lot of movement in that part of the spine. What you describe matches what alot of us feel in the thoracic. Because you have such widespread, uncorrected issues in your neck, it could be that your neck is generating all this and your first fusion is putting pressure downstream. What is a possibility is that if you get multiple levels fused in cervical that this can aggravate those feelings by putting more pressure from the stiffness in the spine from that fusion. Do you go to pain management?

     
    Old 04-28-2008, 02:12 PM   #8
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    ok, I just came back from my ortho and he said there is a question of my fusion not hardening and he also said C6-7 is bulging and protruding and could be possibly causing my pain. He says can't see too good under the fusion on the MRI. He says my reflexes are dimensioned on the left side (the side that hurts)and is indicative of nerve involvment.

    He is really a conservative surgeon and suggested for me to go to pain management and try a steroid shot first to see if helps the pain any and then come back in 6 weeks and see how I'm doing. If not alot better, he thinks I need a mylogram and possibly surgery again to correct it and to extend the fusion.

    He says my thoracic pain could be referred from my neck and is not investigating that further now until we resolve the neck.

    Do you think I should still have a thoracic MRI? What kind of complications can a non union fusion cause?

    I am taking Percocet which dulls the pain, but doesn't take it away.

    What do you guys think?

     
    Old 04-28-2008, 02:59 PM   #9
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    Re: MRI Results..Neck and Arm pain is driving me crazy!

    A non union can result in pain and a less stable fusion than was planned. I would reccomend you go forward with testing and the shots to see what, if anything, can help. A myelogram is also very useful (just had one 2 wk ago).
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