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  • Just got MRI results--input please

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    Old 10-12-2011, 10:07 PM   #1
    Atuafiu
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    Just got MRI results--input please

    So here's my story. 54 years old. Male.

    I was a passenger in car accident when I was 15. Got knocked unconscious when I was 10. I was chasing a friend and got snagged on a sprinkler head, tripped and got banged on the back of the head around the occiput. I woke up hours later in the hospital. I did a lot of surfing and bodysurfing in my teens and twenties, and got slammed head first into the sand multiple times. Yes, I know!

    Surprise, surprise, I have had neck pain since my twenties. I have dealt with it with a lot of chiropractic in the early years. Once I wised up to the detrimental nature of high velocity neck adjustments, I gave that up and got Rolfing structural integration, and have done yoga for decades. These two things seem to have been the only things that have helped.

    Doctors have given me Tylenol 3, then Ambien, followed by Gabapentin, because the pain would interfere with my sleep. I was on the codeine and Ambien for eleven years straight. Three years ago, I tapered off all drugs, which was a living hell for six months.

    I've had ups and downs since going off the meds, but in the last couple of months it's back with a vengeance. I am in pain more or less twenty-four hours of the day, with very tight muscles in my neck and shoulders. When I turn my head on its axis left to right and then tilt the head toward my right shoulder, I can feel a lot more pain at the cervicals, around C3-C4.

    This pain is always there. It's a background noise that sometimes is a lot worse than others, and distraction and exercise help a lot. But the pain is there.

    In the last couple of weeks I get slight tingles in my left thumb and right thumb. I have had this in past and it's always gone away. I do a lot work at a computer and I have had twinges of carpal tunnel syndrome in past if there has been a marathon on the computer.

    When my neck and shoulder muscles get super tight, I can sometimes get slightly dizzy, which I attribute to a lack of oxygenated blood in the tight muscles.

    None of my doctors have ever suggested any further tests or analysis in the past, as I look healthy and am active. You just have to live with pain. Buck up and live with it.

    A little over a week ago, I was in to see my family doctor on another issue, a followup from a deal from six months ago, and I told him about the pain. He did reflex tests, asked about loss of bladder and bowel function, or loss of functioning of any limbs, and this checked out fine. He suggested an MRI to get a better picture of what's really going on in the neck.

    His nurse called back after the radiologist did his thing and said my family doctor wanted me to get in to see a spinal surgeon, and orthopedic surgeon. Well, you can imagine how that made me feel.

    Without further ado, here is my MRI analysis. Any comments you may have will be appreciated.

    -----------------------------
    Reason for Exam
    pain C3-C4

    Report
    MRI of the cervical spine without IV gadolinium. No comparisons available.

    FINDINGS: Congenital narrowing of the cervica; spinal canal most prominent from C3-C4 to C5-C6 secondary to short, squat pedicles. Mild retrolisthesis of C3 on C4. Mild (grade 1) anterolisthesis of C2 on C3. Foramen magnum is patent.

    C2-C3: The anterolisthesis of C2 on C3, with unroofing of the intervertebral disc, partially effaces the ventral aspect of the thecal sac, causing mild spinal canal narrowing. Otherwise negative.

    C3-C4: The retrolisthesis of C3 on C4 with congenital cervical stenosis causes moderate spinal canal narrowing, with complete effacement of the ventral and dorsal aspect of the the thecal sac and mild flattening the ventral cord without underlying cord signal abnormality. Asymmetric left greater than right uncovertebral arthopathy and facet joint hypertrophy cause moderate left and mild right neuroforaminal encroachment on the exiting C4 nerve roots.

    C4-C5: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Asymmetric right greater than left uncovertebral arthopathy of facet joint hypertrophy cause severe right and mild left neural foraminal encroachement on the exiting C5 nerve roots.

    C5-C6: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Left greater than right uncovertebral arthopathy and facet joint hypertrophy cause severe left and moderate right neuroforaminal encroachment on the exiting C6 nerve roots.

    C6-C7: Mild disc space narrowing is symmetrical bulging disc causes mild spinal canal narrowing. Asymmetric right-sided uncovertebral arthopathy causes mild right-sided neural foraminal encroachment.

    C7-T1: Negative

     
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    Old 10-13-2011, 01:42 PM   #2
    WebDozer
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    Re: Just got MRI results--input please

    It never ceases to amaze me how many docs will dismiss you if you're able to get into their office under your own power. Whatever happened to preventive medicine?

    OK, let me, for starters, quote the report re your various levels and comment on each one...

    """C2-C3: The anterolisthesis of C2 on C3, with unroofing of the intervertebral disc, partially effaces the ventral aspect of the thecal sac, causing mild spinal canal narrowing. Otherwise negative."""

    Interesting.... your C2 vertebrae is displaced FORWARD (anterolisthesis). I'll bet that was from trauma during your youth. It's so rare (on this board, at any rate) to see problems that high in the spine that I don't really know what to say. While the displacement doesn't seem to be severe, ANY problem that high up could cause a host of neck problems and maybe even pain in the head. The C2-3 is your highest disk (there is no C1-2), and it is critical for neck range-of-motion. I don't know if this is what caught the doc's eye, but it's something to ask about.

    ""C3-C4: The retrolisthesis of C3 on C4 with congenital cervical stenosis causes moderate spinal canal narrowing, with complete effacement of the ventral and dorsal aspect of the the thecal sac and mild flattening the ventral cord without underlying cord signal abnormality. Asymmetric left greater than right uncovertebral arthopathy and facet joint hypertrophy cause moderate left and mild right neuroforaminal encroachment on the exiting C4 nerve roots.""

    So C2 was displaced forward on C3, but C3 is displaced BACKWARD on C4. I wonder if that isn't ONE problem instead of two, that is, C3 is just too darn far backward? Anyway, even though it may not be displaced very far, it is causing some cord flattening, DUE TO CONGENITAL STENOSIS. That is, you were born with an insufficiently wide spinal canal, so anything that intrudes on it (displaced vertebrae and herniated disks from in front, swollen ligaments from behind, and bone spurs from all over) may also impinge upon the spinal cord. You may have an unrelated problem with abnormal bone growth into your foraminal openings, possibly impinging on the peripheral nerves as they exit the spinal cord. The problem is only at "moderate", for now, but that's a judgment call by the radiologist, so I would not assume that it isn't causing symptoms in left shoulder and arm.

    ""C4-C5: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Asymmetric right greater than left uncovertebral arthopathy of facet joint hypertrophy cause severe right and mild left neural foraminal encroachement on the exiting C5 nerve roots.""

    At this level, instead of a displaced vertebra, you have a displaced disk, which is a little more common. Doesn't seem to be causing a problem (yet) in spite of the congenital stenosis. However, the abnormal bone growth at this level is significantly worse. That "severe" problem on the right side is really something to pay attention to. The C5 controls the deltoid and biceps, as well as the hand to some extent. Is your right biceps weak? Can you lift things using only your right shoulder, as well as you can with the left? When I had a C5 problem, I suddenly couldn't lift with my shoulder, and couldn't "make a muscle" with my biceps.

    ""C5-C6: Degenerative spondylotic change with symmetrical bulging disc and concomitant congenital cervical stenosis causes moderate spinal canal narrowing. Left greater than right uncovertebral arthopathy and facet joint hypertrophy cause severe left and moderate right neuroforaminal encroachment on the exiting C6 nerve roots.""

    Same thing as higher level, except this time the "severe" problem is on the left.

    ""C6-C7: Mild disc space narrowing is symmetrical bulging disc causes mild spinal canal narrowing. Asymmetric right-sided uncovertebral arthopathy causes mild right-sided neural foraminal encroachment.""

    Starting to return to normal at this level.

    OK, you have several kinds of problems: (1) displaced vertebrae up high (although maybe just the C3), (2) some bulging-disk problems, and (3) moderate to severe foraminal narrowing at several levels.

    I just don't know what to say about the antero/retrolisthesis. One neck problem I have never had. As for the rest, I strongly urge you to educate yourself about the three basic kinds of surgery... ACDF, foraminotomy, and laminoplasty.

    The ACDF is the one that every spine surgeon knows, and many will - unfortunately - try to push you into that because that's what they do.

    Since your non-listhesis problems seem to be pretty much limited to foraminal narrowing by bone growths, it would seem that foraminotomies could take care of the problems. The foraminotomy is a mininally-invasive surgery that comes in diagonally from behind and grinds off the abnormal bone growths. I don't know how they'd deal with the fact that you have multi-level and multi-lateral problems. Maybe do multiple foraminotomies in a single session?

    I must say, though, that other than myself I've never seen someone who looks more like a candidate for a laminoplasty, which is a surgery that opens the spinal canal (from behind) and gives the patient more room in the canal. It's specifically for people with congenital canal stenosis. While it's true that your stenosis may not yet be directly causing trouble, I'd guess that it will, soon enough.

    Maybe, though, foraminotomies will be all you need. If a surgeon tries to shoehorn you into an ACDF, though, ask him how that will help your multi-level foraminal-narrowing problems.

    I'm very interested to hear what the surgeon has to say, and hope you will post again. If you have any questions about what I've written, or want elaboration, I'm always happy to supply my amateur opinion.

    Last edited by WebDozer; 10-13-2011 at 01:49 PM.

     
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    Atuafiu (10-15-2011)
    Old 10-14-2011, 09:28 PM   #3
    Atuafiu
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    Re: Just got MRI results--input please

    WebDozer,

    Awesome response. Much appreciated! Thanks so much for helping decode the MRI for me.

    I have an appointment on October 18 with the orthopedic surgeon that I got a referral to by my primary care provider. I will report back what he says.

    You asked if my right bicep was weak (controlled by the C5 nerves). No it isn't and neither is the left bicep.

    The two biggest issues I have are constant muscle tension in my upper back and neck, and pain that I feel on the right side of my neck that I feel in the vertebrae.

    We'll see what the ortho guy has to say on Tuesday.

     
    Old 10-15-2011, 11:59 AM   #4
    WebDozer
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    Re: Just got MRI results--input please

    Atuafiu... Just from reading your MRI, I would have predicted at least some arm symptoms. I think it's fairly safe to say that they're on their way, even if you don't have them yet, assuming the radiologist is not exaggerating in his use of the word "severe".

    Hopefully, your doc will agree that you can get away with just foraminotomies for now. They are a much milder form of surgery than the alternatives.

    Please post back with what he says, especially about that C3 retrolisthesis.

     
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