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    Old 08-19-2011, 01:47 PM   #1
    trustykaren
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    Can someone read this MRI in laymans terms? (be a huge help)

    I would greatly appreciate it . Thank you so much, this is for lumbar spine and cervical. Mainly cervical problems. It is for my mother and we are considering the possibility of surgery , which of course will take many doctors opinions and research though.


    MAGNETIC RESONANCE IMAGING OF THE LUMBAR SPINE:

    clinical indication: severe pain, disc bulge

    female with low back pain radiating to the
    right leg. (was at time she was having sciatica pain)

    TECHNIQUE: MRI evaluation of the lumbar spine was accomplished using
    T1 and T2 weighted sagittal sequences, as well as T2 axial sequences
    from T12 through S1, and T1 axial sequences from L3 through S1.
    Sagittal STIR image of the lumbar spine was also performed.

    FINDINGS: Lumbar spine demonstrates normal alignment. Vertebral body
    heights are preserved and no vertebral compression fracture is seen.
    Small anterior marginal degenerative vertebral osteophytes are noted
    within the lower thoracic and lumbar spine most pronounced at the
    L5-S1 level anteriorly. End plate discogenic marrow changes are seen
    at L5-S1.

    Conus medullaris is in expected position. Distal cord demonstrates
    normal bulk and signal intensity.

    Intervertebral discs at the T12-L1 and L1-2 levels demonstrate normal
    height and signal intensity for age. No focal bulge or protrusion
    present. Exiting and traversing nerve roots unremarkable.

    L2-3: There is minimal annular disc bulge without focal protrusion.
    Exiting and traversing nerve roots unremarkable.

    L3-4: Intervertebral disc is within normal limits. No focal
    protrusion noted. Exiting and traversing nerve roots unremarkable.
    There is mild facet osteoarthritic change noted on the right with some
    small synovial cysts projecting posteromedially adjacent to the
    spinous process.

    L4-5: Intervertebral disc demonstrates mild annular bulge which
    touches but does not displace the descending L5 nerve roots within the
    lateral recesses. There is mild to moderate bilateral facet
    osteoarthritic change present.


    L5-S1: Annular degenerative spur formation is present with associated
    mild annular disc bulge. Disc osteophyte complex touches but does not
    displace the descending S1 nerve roots within the lateral recesses.
    Disc osteophyte complex also touches the exiting L5 nerve roots within
    the foramen. There is mild bilateral facet osteoarthritic change
    noted.

    Impression:

    1. Disc bulge L4-5 level which touches but does not displace the descending L5 nerve roots within the lateral recesses
    2. Disc osteophyte complex L5-S1 which touches the exiting L5 nerve roots within the foramen and descending S1 Nerve roots within the lateral recesses bilaterally
    3. Mild Facet osteoarthritic change as described above



    ___
    MAGNETIC resonance imaging of the cervical spine


    TECHNIQUE: An MRI examination of the cervical spine was accomplished
    using T1 and T2 weighted sagittal sequences, as well as 2 mm gradient
    echo axial sequences from C2 through T1. Sagittal STIR image of the
    cervical spine was also performed.

    FINDINGS: Comparison study is dated May 2008 Cervical spine
    demonstrates straightening of the normal lordosis. Vertebral body
    heights are preserved and no fracture or dislocation is noted.

    There are anterior degenerative vertebral osteophytes present at the
    C4, C5, C6, and C7 levels.

    Cervical cord demonstrates normal bulk and signal intensity.
    Cerebellar tonsils are in expected location.

    C2-3: Intervertebral disc is within normal limits. No bulge or
    protrusion present. Cord, canal, and foramen patent.

    C3-4: Intervertebral disc is within normal limits. No bulge or protrusion present.
    There is mild facet osteoarthritic change present on the left.
    Cord, canal, and foramen patent.

    C4-5: Small degenerative uncovertebral spurs are noted as is mild
    bilateral facet osteoarthritic change. No focal disc protrusion is
    present. Cord, canal, and foramen patent.

    C5-6: Intervertebral disc demonstrates decreased height and signal
    intensity. There are degenerative uncovertebral spurs with associated
    annular disc bulge. Disc osteophyte complex causes flattening of the
    thecal sac and cord with narrowing of the canal diameter to
    approximately 8 mm. There is mild bilateral facet osteoarthritic
    change left greater than right. Moderate left and mild right
    foraminal narrowing present. Findings are similar or perhaps slightly
    worse when compared with previous study of 2008.

    C6-7: Intervertebral disc demonstrates decreased height and signal
    intensity. There are degenerative uncovertebral spurs present with
    associated annular disc bulge. Disc osteophyte complex causes
    flattening of the thecal sac and slight flattening of the left central
    cord. Anteroposterior canal diameter is measured at 10 mm. Bilateral
    facet osteoarthritic change present left greater than right. There is
    some mild foraminal narrowing noted bilaterally. Previously noted
    left lateral disc protrusion is no longer seen and has been replaced
    by broader based disc bulge with uncovertebral spur formation.

    C7-T1: Intervertebral disc is within normal limits. Cord, canal, and
    foramen patent.

    IMPRESSION:
    1. CERVICAL CANAL STENOSIS C5-6 SECONDARY TO
    UNCOVERTEBRAL SPUR FORMATION AND ANNULAR DISC
    BULGE. THERE IS ALSO MODERATE LEFT AND MILD RIGHT
    FORAMINAL NARROWING AT THIS LEVEL SECONDARY TO
    ANTERIOR AND POSTERIOR ELEMENT DISEASE.
    2. DEGENERATIVE DISC DISEASE AND UNCOVERTEBRAL SPUR
    FORMATION C6-7 LEVEL WHICH FLATTENS THE THECAL SAC
    AND CORD ON THE LEFT BUT DOES NOT CAUSE CENTRAL
    SPINAL CANAL STENOSIS.
    3. DEGENERATIVE DISC DISEASE AND FACET OSTEOARTHROPATHY AT OTHER LEVELS AS DESCRIBED ABOVE.

     
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    Old 08-19-2011, 05:30 PM   #2
    WebDozer
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    Karen, after I've induced you to do all that typing, I guess I owe you an answer.

    My overall impression is that I wish my MRI read that well, and your mother must be somewhat older than I am.

    When I read these things I watch the adjectives, as the radiologist will tell you how far out of whack he thinks something is by his use of minimal, mild, moderate and severe (yours adds "small", which I'll associate with "mild"). You'll have a hard time getting a doctor to pay attention to anything that isn't at least "moderate" and a surgeon will likely want to see "severe" before acting.

    I didn't see "severe" anywhere, and remember "moderate" in only two places.

    The radiologist seems to think that if there is a lumbar problem causing the leg pain that it's at L4-5 and/or L5-S1. So the nerve roots are "touched" but not "displaced"? I WOULD read that as an POTENTIAL problem, except that your mother seems to have an EXISTING problem. I guess those nerve roots must be "touched" a little unkindly.

    The cervical seems to be a more advanced situation. The "straightened lordosis" means that the normal backward bend of the cervical spine has been lessened. Hopefully not a problem, as is, but you wouldn't want to see it progress much further in the direction of "kyphosis" (forward bend).

    The radiologist goes right to the C5-6 level in his impressions. While a flattening to 8mm is hardly extreme (I have twice had my cervical cord compressed to 5mm), still, a flattening is a flattening. The cord is being pressed on hard enough to compress it, and that likely has consequences (although I have been told that a cord compressing very slowly over a long period likely will have fewer symptoms that a compression occurring more quickly).

    Compression of the cord can cause symptoms at any level below the compression, to the extent that even cervical compression can cause leg symptoms (I am tempted to say that most leg symptoms (sciatica?) have lumbar origins, but I don't really know. I do know that doctors asked about sciatica will look at the lumbar first.). The symptoms caused can be bilateral, although the flattening is often more pronounced on one side than the other, and the symptoms may correspond to that.

    At C5-6 the left side foraminal narrowing progresses to "moderate". Does your mother have problems mostly with the left side of her neck, and her left shoulder/arm/hand?

    I don't know what he means by "element disease", but I would note that in this context, "disease" does not mean something like malaria or diabetes, but is likely just a structural problem (e.g. "degenerative disk disease" means the disks have collapsed). Frankly, it sounds like he's not being as specific as he might be.

    I don't see any smoking guns, exactly, although the flattening at C6 seems of greatest concern. I'd want to learn more about that straightened lordosis, what causes it, what symptoms it might cause, and where it might progress. Radiculopathy (nerve root problems) COULD be present at many levels, but nothing jumps out, exactly.

    Please keep in mind that I'm an AMATEUR. The only advice I feel confident in giving is that you should PURSUE this matter until you are satisfied. Just as there are surgeons who see every problem as amenable to surgery, there are "old school" doctors who see surgery as something to avoid if at all possible, who will want you to try everything short of incantations first. Hopefully, you can find someone who's more balanced than that.

    Last edited by WebDozer; 08-19-2011 at 05:39 PM.

     
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    Old 08-19-2011, 07:54 PM   #3
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    WebDozer thank you so much, i cannot express it enough. I have a couple more followup questions if you dont mind and anyone else willing to chip in I thank you so much. I hope the best of luck with your situation as well. I will be looking into everything you wrote and getting myself familiar with the topic. You seem to know a lot and I applaud you for that, and looking into the details of your own situation. How are you progressing?

    Thanks I will definitely be asking more about the straightened lordosis and what causes it/the symptoms/where it will progress. I think we might be taking her to a neurologist soon at least.


    Quote:
    Originally Posted by WebDozer
    At C5-6 the left side foraminal narrowing progresses to "moderate". Does your mother have problems mostly with the left side of her neck, and her left shoulder/arm/hand?
    Yes actually she has a lot of pain in her left arm currently. That's actually the reason I have increasedly been worried and had made me post this. I had no idea there would be great helpful people like you online to help with something like this. And shes been taking Hydrocodone/Acetaminophen + cyclobenzaprine

    Should I ask about treating causes/symptoms related to C5-6 so it would ultimately help with her left arm pain? This MRI is from last year, so I hope the C5-C6 hasnt gotten worse than 'moderate'.

    And oh yes, definitely will be not considering surgery until everything else is considered! Thank you again for your huge helpful response and take care

    Last edited by trustykaren; 08-19-2011 at 07:56 PM.

     
    Old 08-20-2011, 07:40 AM   #4
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    """Should I ask about treating causes/symptoms related to C5-6 so it would ultimately help with her left arm pain? This MRI is from last year, so I hope the C5-C6 hasnt gotten worse than 'moderate'."""

    I didn't realize the MRI was that old (8-20 months). Certainly you and your doctors will want to update at least the cervical one. If a doctor doesn't want to update the MRI, you might want to find one who will. It's your judgment.

    In the absence of trauma, the changes will be gradual and incremental, but certainly enough time has passed for "mild" to become "moderate" at some levels, and for "moderate" to become "severe". Unfortunately, it's very unlikely that things have moved in the opposite direction.

    """And oh yes, definitely will be not considering surgery until everything else is considered!"""

    I hope you didn't get the impression that I thought you should be so averse to surgery. After all, I have already had three. I was just suggesting you watch out for doctors who are either too eager to operate or too fearful of operating. Surgery is getting better and safer all the time, and some older doctors may still be basing their opinions on biases developed years ago.

    Anyway, I hope you get another MRI. When you do, get the radiologist's report right away, then compare it to the old one, noting at each level where the verbiage has changed. It might be a good idea to try to get the same radiologist, just so you don't see differences that are only caused by different radiologists' "style". Then, if you like, you can come back here and get some more amateur and wholly unqualified opinions.

     
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    Old 08-22-2011, 09:59 AM   #5
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    Quote:
    Originally Posted by WebDozer View Post
    """Should I ask about treating causes/symptoms related to C5-6 so it would ultimately help with her left arm pain? This MRI is from last year, so I hope the C5-C6 hasnt gotten worse than 'moderate'."""

    I didn't realize the MRI was that old (8-20 months). Certainly you and your doctors will want to update at least the cervical one. If a doctor doesn't want to update the MRI, you might want to find one who will. It's your judgment.

    In the absence of trauma, the changes will be gradual and incremental, but certainly enough time has passed for "mild" to become "moderate" at some levels, and for "moderate" to become "severe". Unfortunately, it's very unlikely that things have moved in the opposite direction.

    """And oh yes, definitely will be not considering surgery until everything else is considered!"""

    I hope you didn't get the impression that I thought you should be so averse to surgery. After all, I have already had three. I was just suggesting you watch out for doctors who are either too eager to operate or too fearful of operating. Surgery is getting better and safer all the time, and some older doctors may still be basing their opinions on biases developed years ago.

    Anyway, I hope you get another MRI. When you do, get the radiologist's report right away, then compare it to the old one, noting at each level where the verbiage has changed. It might be a good idea to try to get the same radiologist, just so you don't see differences that are only caused by different radiologists' "style". Then, if you like, you can come back here and get some more amateur and wholly unqualified opinions.
    Thank you very much. Im gonna try to do this with the new MRI you suggested.. appreciate it SO much.

    Anybody else have more suggestions on the reading of the MRI?

     
    Old 08-22-2011, 12:07 PM   #6
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    I'll add a couple of things to Webdozers great explanation.

    Cervical.....you can tell when a moderate compression goes to severe by the symptoms. Your mom will get more numbness, tingling and muscle weakness and the pain will actually go down. Less pain is bad when you've been in pain for a while. As the nerve gets more and more compressed to the point where there is a chance of nerve death, the symptoms start to look like early paralysis..weak muscles, slight numbness that might not show up as profound numbness but like you can't feel a bug bite or small cut(I couldn't feel when I tested my fingertip for my blood sugar) and you drop a lot of things as you think you are holding on tight and you aren't(called Clumsy Hand Syndrome). Some things to watch for.

    Lumbar...........unlike the neck, the nerves can become compressed not only inside the vertebra but outside(what they call extraforaminally). A large disk herniation/bulge can hit the nerve as it comes around from the back of the vertebra to the front. This is where the MRI reports the nerve being "touched". This can progress to full compression but right now, this is the painful time. Once the nerve is fully compressed, again, numbness and weakness will show up.

    Your mom is at that point where she is in maximum pain but not yet to the point where she needs surgery. Some surgeons will operate when they see a cord compression to 8mms but as Web was , I was also 5-6mms at 4 levels in my neck before anyone touched me. At least one person here was 4mms. The reason the docs wait is that you risk a chance of paralysis during surgery so you need to be in danger of it to justify surgery to a good surgeon.

    This is a really hard place to be...so much pain yet not enough to justify surgery. Fact is, a good surgeon will not operate for pain...they wait for the signs of a nerve in danger(numbness and weakness) or a spinal cord in danger(trouble walking, numbness in the feet or toes, stiff or weak leg muscles, trouble with balance). So that is what you need to watch out for before committing to surgery. She may need it down the road.

    Jenny

     
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    Old 08-22-2011, 01:22 PM   #7
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    Webdozer and Jenny have given great information. Perhaps I missed it but is she scheduled to see an Orthopedic Spine Surgeon and/or Neurosurgeon? I agree that it might not be the time for surgical intervention (and don't fall victim to the laser centers that claim minimally invasive cure. There's a chain of them out there that are not what I'd call reputable and they prey on those with pain). BUT, as OSS or NS can discuss non surgical options including physical therapy and pain management. I was able to defer cervical spine surgery for years with ESI (epidural steroid injection) for pain relief and it also helped for lumbar pain as well.

    A good Pain Mgmt physician can help with a variety of modalities. It's important to find one that truly listens and takes time to talk about options (sometimes that can be had to find so don't be afraid to see a few PM doctors). Make sure someone goes with her who can advocate, listen, and help her understand the options. Too often the process of PM seems overwhelming so I took hubby with me a few times and even a friend with lumbar/cervical issues as well.

    If you look at a spinal dermatome chart you'll see where we most often feel pain, numbness, and tingling when there is a problem at a specific level of the spine. If at any time she has extreme numbness, foot drop, change in symptoms she needs to then see if some type of surgery may be required. My neck did okay for years until 2 fingers went numb and didn't improve with ESI and the OSS said it was time to operate or the symptoms could become permanent. My neighbor had back probles for 10 yr. He did well with PT, ESI, and some medications like Neurontin for nerve pain. The morning he woke up and had foot drop (foot can't be held in neutral position and just droops) his wife took him to a surgeon and it was time to do a spine fusion. Within 3 mo his foot was back to normal. Nerves take a long time to heal so it's often a slow process to see if PT or ESI or medications, etc, are working.

    Please don't be alarmed at my surgical history, it's not typical. I have always had very lax ligaments and tendons leading joints (from feet to hands to spine to knees) to move to much and cause problems that need a surgical fix. At 45 I'm headed for a knee replacement 9/28 just due to years of an unstable knee.
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    Old 09-11-2011, 06:46 PM   #8
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    Thank you guys very much. What are your experiences with physical therapy when you have a pinched nerve causing arm weakness/tingling/numbness? And your experience with Cortisoid injections? I feel this recommendation by the doctor may be too light as my mom has already done physical therapy before... no medication was prescribed and we are not scheduled for an MRI yet. (even though the last MRI is over a year old)

    We've been recommended for physical therapy and cortisoid injections.

    Would it be possible to contact the doctor and push for an MRI through the phone, cause I think we should get it and scheduling another appointment just to ask for it seems a bit redundant when shes already seen the MRI and knows the problem is bad you know?

    Last edited by trustykaren; 09-11-2011 at 08:08 PM.

     
    Old 09-11-2011, 08:13 PM   #9
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    Quote:
    Originally Posted by jennybyc View Post
    I'll add a couple of things to Webdozers great explanation.

    Cervical.....you can tell when a moderate compression goes to severe by the symptoms. Your mom will get more numbness, tingling and muscle weakness and the pain will actually go down. Less pain is bad when you've been in pain for a while. As the nerve gets more and more compressed to the point where there is a chance of nerve death, the symptoms start to look like early paralysis..weak muscles, slight numbness that might not show up as profound numbness but like you can't feel a bug bite or small cut(I couldn't feel when I tested my fingertip for my blood sugar) and you drop a lot of things as you think you are holding on tight and you aren't(called Clumsy Hand Syndrome). Some things to watch for.


    Jenny
    thanks a lot jenny.
    So my mom has numbness and tingling and the doctor mentioned like you did that is actually worse than pain.. because nerve damage is worse than pain. But we were still not issued an MRI, though the last ones a month old. Shouldnt the doctor have recommended we get that?

    Also im scared about what you said on the Clumsy Hand Syndrome because my mom actually mentioned to me today that she is dropping a lot of things lately.

    thanks jenny. really interested to hear your thoughts on Clumsy Hand Syndrome

     
    Old 09-13-2011, 06:20 AM   #10
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    has she been checked for Chiari malformation .

     
    Old 09-13-2011, 08:39 AM   #11
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    Re: Can someone read this MRI in laymans terms? (be a huge help)

    KAREN:

    What testing has she had done? I wasn't sure what you mean by being issued an MRI since I see MRI results above in your first note. In most cases once someone has an MRI they are given the films either on DVD or in large envelope. Those are the patient's films to keep. And the report of findings can be requested from the testing facility at any time.

    If you need to be able to talk tot he doctors have her type out something to the effect of:

    "I (NAME) am providing this authorization so that my daughter (full name) can speak with Dr. X and any member of his staff in regards to all aspects of my treatment, conditions, medical records, and test results. This authorization remains in effect until I withdraw it in writing"

    Have her sign it, print her name below it, and date the authorization letter. Then fax it to the doctors office. 1 day after that you can call the doctor's office and request an MRI be done based on her symptoms likely being a result of issues in the spine.

    What type of doctor is she seeing now? What have they said are the next steps in treatment and evaluation?
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    Last edited by SpineAZ; 09-13-2011 at 08:48 AM.

     
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