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    Old 12-21-2011, 03:50 PM   #1
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    Question Help w/ Cervical & Brain MRI Reading & off 2 University Drs..

    Hi Everyone,

    Glad to have found such a wonderful and through site and to now be a part of it. I was injured via a lifting injury at work in '08 and was informed that I had a 5mm bulge in my L5/S1 disc. However, I complained of immense pain and for 2 yrs I had gone through an enormous amount of treatments - everyone possible. I was even offered a Spinal Cord Stimulator at one time but I had refused it. Finally in mid of 2010 I met a Pain Mgmt Dr and he was one of the greatest Dr's I had seen in those 2 years. He knew that I was not lying about my pain and he could truly see it and took it to heart. To this day I am still very thankful to have met him. He sent me back to the same surgeon's office, which had dismissed me shortly after my injury and told the surgeon that my pain was no joke and I needed a spinal fusion. The surgeon ordered the PM to do a Discogram and it concluded that the fluid in my disc indeed came out when I had the initial injury. They indicated to me that "You have been walking around for 2 yrs with bone rubbing on bone and compressed nerves." Needless to say I was floored because for 1.) I had never in my life been injured in any way - no sprain, fracture, nothing - just allergies and sick here and there and 2.) I knew nothing about a spinal injury and nerve compression. I am going on year 4 now and after I had the spinal fusion it seems that everything has begun to go downhill rather than uphill. And, I am only 34 yrs old. I have two children between the ages of 5 and 11 and it was incredibly difficult to go through this past year enduring all these new onset of conditions and symptoms. I have a huge list of items and I never get any good news at the Dr's or Surgeon's offices - always seem to be worsening. I have begun to read spiritual and meditation books and be more open to friends and family about what I am going through as they have had a very hard time w/ acceptance and understanding. I can imagine they do as most of my family lives in other states therefore they don't see exactly what I am going through or see me on a daily basis and can only go by what I say and tell them.

    To continue, as I mentioned, since the fusion things have completely worsened and gone downhill. I have listed my diagnosis' under the diagnosis box on my profile so you can get a glimpse of the "just under 30" items on my list. And, recently I had a Cervical and Brain MRI ordered by a new Pain Management Dr that I have been seeing. He ordered it because he said that my symptoms were beginning to sound like I have nerve compression in my neck and I started to enforce how much pain I feel spark up my back and neck, how it hurts horribly when I stand for longer than 10 mins and afterwards my legs and feet get completely numb and I start to get dizzy and off balance. If I sit for longer than 20-30 mins. then the pains go straight up my back and into my neck and arms and then into the sacral regions. It's really a lose/lose situation. With any/all activity I pay for it tremendously and the PM's PA indicated I could also have CRPS after I went in for a EMG/NCS and it flared me up completely for 5 days straight. After the EMG/NCS I had incredible pain and numbness in my left leg (always seems to worse on my left side of my entire body) and my foot and toes were hypersensitive in the means of putting a shoe on, or even having the blanket touch them, it felt as if one was holding a taser to my foot

    I had the MRI done 2 weeks ago and I saw my surgeon this week and he said "Well I will say your cervical MRI does indeed look scary." He wants to send me to a University for help and to see a team of Neuromuscular Dr's. I will say that I am pretty scared and have no idea what to anticipate there and after this wonderful long story of mine I was hoping for some advice on what to anticipate while there as well as if anyone could assist in the reading of my MRI Report?

    Here is the recent findings and MRI Report of my Cervical and Brain

    Findings: Minimal leftward convex cervicothoracic curvature is identified. This may be positional. No supraclavicular masses or lesions identified. Mild mid cervical kyphosis and reversal of normal lordosis is evident without subluxation, marrow infiltration or fracture. 3mm right and 2mm left cerebellar tonsillar ectopia is identified without Chiari malformation.

    C2-C3 disc is unremarkable.

    C3-C4 shows minor degree of spondylosis and degenerative changes without significant foraminal or canal stenosis.

    C4-C5 disc is mildly degenerated with mild annular bulging and minimal midline thecal sac effacement. This rests just ventral to the cord but without cord indentation or compression. Foramina and canal are patent otherwise.

    C5-C6 level: Moderate disc degeneration is evident with broad-based posterior disc bulging and symmetric spondylotic spurring causing mild foraminal encroachment and diffuse thecal sac effacement. No cord compression or cord edema.

    C6-C7 level: Chronic disc degeneration is evident with mild right-sided bulging and a shallow left central disc protrusion adjacent to the left ventral C7 rootlet. Are the patientís symptoms in a left C7 distribution? Mild left foraminal stenosis is evident.

    C7-T1 and other upper thoracic discs show minor degrees of degeneration only. Cervical and upper thoracic spinal cord is normal caliber and signal. No evident paraspinal mass or muscle edema. Normal flow void within the vertebral arteries and cervical carotid arteries. Facet joints are intact. No apparent facet erosion No areas of marrow infiltration.

    1. Mild reversal of the normal cervical lordosis with minimal kyphosis centered at C5. No subluxation, marrow edema or fractures.

    2. Mild multilevel degenerative disc disease from C3-C4 through C6 and C7. Asymmetric left-sided shallow disc protrusion at C6-C7 appears to efface the thecal sac adjacent to the left C7 ventral rootlet.

    3. Mild broad-based disc bulging and mild spondylosis bilaterally at C4-C5 and C5-C6. Thecal sac is effaced without distinct cord compression.

    4. No evident underlying myelopathy.

    BRAIN Findings:
    10mm caliber retention cyst is seen in the floor of the right maxillary sinus. No air-fluid levels. Other sinuses appear clear. Ventricular system is normal in size, shape and position. 2 mm left and 3 mm right cerebellar tonsillar ectopia is identified without findings of Chiari malformation. No mass effect or upper cord compromise. Brainstem and cerebellum are unremarkable. Gray-white differentiation is maintained with no findings of infarction, ischemia, mass or hemorrhage. Mildly prominent perivascular spaces are seen inferior basal ganglia regions. Cortical sulci appear symmetric with no areas of focal atrophy. Orbital soft tissues are symmetric. Calvarium and skull base are intact. Normal flow within the carotid siphons and basilar artery.

    Thanks to everyone and anyone who has taken the time to kindly read all of this and, ahead of time, I truly appreciate your remarks, honesty and truth I do feel that I have learned a mass amount of new terms since this is going on year 4 but I will say that I feel I am enduring the upper back pain due to compensating the usage of it from the fusion of L5/S1 last Aug. Is this possible or a regularity that occurs? I also endure mass pain in my left arm (bicep - under not top) and I have to wear wrist braces every night or my hands go completely numb and I get shooting pains that run down both arms which won't stop for a good hour every night. I take double to triple the time to do things that I use to do and have adjusted and am accepting this new life path. However, as I said earlier, I am scared of this MRI reading and don't fully understand what it all means, or the medical terms/word usage, and I don't know what to expect while at a University with a team of Dr's. Any help is greatly appreciated :-)

    Thank you kindly and I look forward to any and all replies. Happy Holidays to ALL

    Still thinking positive and hanging in there for myself, family and friends,


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    Old 12-25-2011, 05:37 PM   #2
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    Re: Help w/ Cervical & Brain MRI Reading & off 2 University Drs..

    Hi Justsmurfy.....I'm Jenny and one of the people who "attempts" to explain MRI's in plain English. I've had 2 major neck surgeries myself and possibly facing a third so I have to do this for myself as well.

    So a little anatomy. The spinal cord descends out of the back of the brain. the first thing they are seeing is that the very lowest part of your brain is slightly longer than normal but they aren't seeing a "Chiari malformation" that is congenital and affects that area so you are okay there. the first 2 vertebrae of the neck at C1 and C2 and they move your head. No disk between them.

    Starting at C2, a pair of spinal nerves peels off the cord at each vertebrae and leaves the vertebra by small holes in the bone called foramina. In between each vertebra there is a disk(as you know all too well) and it is "butt up" against the spinal canal so if it rupture backwards, it can hit the spinal cord or the nerves. Or it the disk material can develop bone spurs along the edge and that hits the cord or nerves or blocks up those holes where the nerves exit. Those are the major pain producers as well as arthritis of the tiny joints that form the vertebrae(and you thought you were dealing with just one joint!). The joints that cause the most problems are the facet joints and uncovertebral joints. They are basically bone protrusions on the sides and back of the vertebrae that interact with other protrusions above and below to give stability to the spine.

    So starting at C2-3(they use the disk space the focus of the MRI rather than each single vertebra) are fine. problems except some "spondylosis"...fancy word for spine arthritis. have "mild" degeneration of the disk and an annular bulge that is going backwards toward the cord. It "indents" the "thecal sac". The thecal sac is the membrane that encases the cord and holds in the spinal fluid around the cord so your bulge is hitting the sac at the front(ventral) of the sac but it is NOT touching the cord or indenting the cord at all. Nor is anything blocking the nerves to your body or making the spinal canal smaller. the disk problem is worse(moderate) and is larger and has some bone spurs attached to it(spondylitic spurring). It is going backwards into the canal and hitting the thecal sac again but not the cord(always important...they can tell as the cord isn't swollen..edema) and is "mildly" blocking the foramina where the nerves exit to the body. More on the designation of "mild" later. the disk has 2 to each side. The right sided bulge is not touching anything but the left sided one is right where the hole for the nerves is(foramina) and they categorize the amount of blockage as "mild" and have speculated that it might be the cause of your arm pain. No cord or canal problems here.

    C7-T1...just shows minor degeneration(arthritis).

    The arteries that go up to the brain from C6 up to the brain look fine as do the carotids. No bone masses or bone marrow problems. BUT, you do have what they call a "mild reversal of cervical lordosis" what that means is that your neck, rather than having a nice inward curve, it getting straighter....something that happens with age but can also occur from injuries. But they don't see any "subluxations"(fancy word for dislocations) or breaks.

    Now to explain that word you've seen a lot in the report...mild. Radiologists rate the amount of "problem" they see with the words, Minimal, Mild, Moderate and Severe. the only place they have used the word moderate is in describing the amount of degeneration of the disk at C5-6 so if you give it a numerical value, think of that disk as being a 3 out of 4 in degeneration. But everywhere else, it's Mild....or 2 out of 4 as far as amount of blockage of the holes the nerves go through(at C6-7 on left and both sides at C5-6) or amount of disk degeneration and disk bulge(as with C4-5).

    Mild is good news. Most spine surgeons do not operate until you reach the severe level with nerve blockage or compression. With regards to the spinal cord being affected, they usually don't operate until the cord is being indented to a moderate level and has been reduced in size to to at least 8-9mms from 10-12mms. So I don't see surgery in your future.

    I just had an EMG/NCS done on both my legs(have had several done on my arms too) and I walked out with no lingering pain so I am wondering if you don't have CRPS developing. BTW, your brain MRI looks fine. And honestly....I wish my neck as as good as yours. Those "mild" nerve compressions can cause pain but shouldn't cause that much pain. Moderate is where the pain really goes up and by the time you hit severe, you are starting to go numb. That is what makes the docs jump into action as once numb, you are at risk if a nerve dying.

    Nothing in your neck seems related to your lumbar me at least.

    Any questions, we are here and I know others will drop by with their opinions about the situation.

    good luck.............Jenny(fused C3 to t1)

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    JustSmurfy77 (12-27-2011)
    Old 12-25-2011, 06:47 PM   #3
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    Re: Help w/ Cervical & Brain MRI Reading & off 2 University Drs..

    I'm sorry for all your troubles. Unfortunately, I have to second what Jenny said about the cervical MRI, that is, that nothing really jumps out as being immediately problematic. The only thing is that left C7 nerve (which would affect, among other things, the triceps and the middle two fingers). The radiologist was kind enough to let your other docs know that he thinks it MIGHT be a problem. First time I have ever seen a radiologist speculating in that manner. I really doubt that a surgeon would recommend any cervical surgeries, at least not yet.

    Old 12-26-2011, 06:47 PM   #4
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    Re: Help w/ Cervical & Brain MRI Reading & off 2 University Drs..

    Hi Jenny!

    Thank you so much for taking the time out of your day to look over my MRI and fully explain it all to me. This has, and will continue, to help me incredibly. You are a wonderful person and extremely intelligent to know all this and to have the generosity to help others. I am very grateful to have gotten a reply with such impeccable details. My pain mgmt (PM) Dr's Assistant actually indicated herself that she felt it could be related to CRPS as well but then when I saw my PM this past week he sort of steered away from that and said he feels very strong that may have Chiari Syndrome even if the MRI did not show it. He said not always does it show it and my symptoms are too closely related to it. I am truly praying that going to the University will help me in finding/figuring out some type of diagnosis and treatment care and that I don't have Chiari Sydrome. I did look that up and it doesn't sound very good. I also read about CRPS and, again, have all the symptoms for that as well. I feel that I may have that myself. I am a bit worried about the neck herniation's, especially the one that has herniation's on both sides. For a good week now, I have woken up throughout the night with horrible shooting pains in either arm and complete numbing in wrists and hands - even with my carpal tunnel wrist braces. And, each morning my right arm is completely numb for a good hour until I move around and get it flowing. I am going to try to sleep with one pillow or even none and see if that makes a difference. I feel it worsening and the shooting pains that I wake up to hurt incredibly as well as the morning stiffness in my hands. I am sorry that you have had multiple fusions but very glad you were lucky with the majority of them or at least seemed to be. I am a bit worried about the pains, numbing and taking an hour to go away and even wakening from it during the evening so I will mention it to my PM on our next visit and see what he says.

    Again, thank you so much for your reply and thoroughness with all the medical explanations and terms. I am very appreciative and thankful.

    JustSmurfy77 -)

    Old 12-26-2011, 07:00 PM   #5
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    Re: Help w/ Cervical & Brain MRI Reading & off 2 University Drs..

    Ooops I re-posted the same thing to Jenny twice so I am using this opportunity to erase it and fix it. I was about to create a new reply to Webdozer but will do it here instead. I'm glad I caught that one.

    Thank you very much for the honesty and sincerity Webdozer. I do appreciate as well. As you can, from my post above, that I am having much more numbing in and throughout my arms so I do wonder if it is the C7. However, you were correct and my surgeon indicated he did not want to operate but followed it up with "because it is sitting so close to the nerve" - I am very happy that you said you've never seen a radiologist question something such as this, so I am thankful for that side note and to the radiologist who was kind enough to question that.

    Much appreciation,


    Last edited by JustSmurfy77; 12-26-2011 at 07:07 PM. Reason: Posted twice so I'm editting 2 make my 2nd reply rather than have the same post appear twice.

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