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    Old 03-15-2012, 05:15 PM   #1
    Kym617
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    New here... please help me understand MRI

    Hi,
    Ive been lurking around for a couple of weeks now. Ive been debating posting my MRI results for fear of what you guys may say. Im finally getting the nerve to post here... before I do so I want to say that IVe learned alot already just from reading and you guys have made me feel better already and didnt know it....haha you all have been through so much and are a wealth of information so thanks in advance!!

    Ive had alot of pain in my right arm along with numbness is my index and middle fingers.. although the numbness started after the mri. neck feels stiff and sore alot and debilitating pain in arm back and shoulder. I traveled to Phoenix on business Feb 6-9th. When I returned home the problems began. I was thinking it was from the heavy carry on bag that I carried bag from Phoenix with alot of heavy files! I also walked three blocks at least twice a day from hotel to conference center carrying the same bag. I thought this was brought on from all that but now after mri im realizing that it may have aggravated a condition that already exsisted.

    I have been out of work since Feb 20th. took forever to get into a ortho dr but once i was there had mri and she told me that I needed to see a neurosurgeon. Im scheduled to see him on the 26th of March.

    history: neck pain right sided radiculopathy

    technique: multisequence and multiplanar MRI imaging of cervical spine performed without intravenous contrast

    findings: alignment of the cervical spine is within normal limits. No abnormal signal involving the cervical spinal cord is identified. There is mild bulging of the C6-C7 disc space which causes mild spinal stenosis. There are small posterolateral osteophytes at C5-C6 which cause mild narrowing of the bilateral neural foramina. There are posterolaterall osteophytes at C6-C7 which cause moderate bilateral neural foraminal narrowing. There is a rigth paracentral disc herniation at C6-C7 which midly indents the anterior right aspect of the cord. This also causes neural foraminal narrowing.

    Impression:
    1: At c6-c7 there is a rigth paracentral disc herniation which indents the anterior right aspect of the cord and slightly posteriorly displaces the cord. The disc herniation also narrows the right foramen to a moderate degree.

    2: No other disc herniation seen.


    thanks again in advance for anyones help in what I may be up against... Im really scared of having a neck surgery and especially a fusion... is it possible NOT to have a fusion!!

     
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    Old 03-15-2012, 06:19 PM   #2
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    Re: New here...please help me understand MRI

    Hi Kym...glad we've made you feel a little better about your situation.

    Let's start with a little spine anatomy. Your spinal cord comes off the base of the brain and goes down into the vertebrae. C1 and 2 are first and they rotate and hook together to move your head. At each vertebra except C1 there are a pair of nerves that peels off the cord and go out to the body...one nerve to each side. In between the vertebrae are the disks, big spongy pads that cushion the bones. The backside of the disks abuts the spinal cord canal so if you happen to get a rupture of the disk at the back, then it go into the canal and affect both the cord and the nerves. They rate the amount of compression or blockage either of the cord or the nerves with the terms minimal, mild, moderate and severe.

    Your neck looks okay except for 2 areas...C5-6 and C6-7. Since disks cause the most problems, they look specifically for the area between the vertebrae so that is why you have 2 vertebrae listed in each level.

    At C5-6 you have some osteophytes...bone spurs caused by arthritis...in the posterolateral(postero...back and lateral...to the sides) of the disk or the front and sides of the spinal canal...the disk is right up against the front of the canal. They aren't bothering your spinal cord but the are blocking the hole(foramen) where the spinal nerves go out to the body...but it's listed as mild. But mild still hurts.

    At C6-7, you have both disk and bone spur problems. You have a right paracentral(to the right of center)disk herniation that is pressing on your spinal cord to a mild degree causing the cord to be pushed very slightly to the back of the spinal canal. This sounds worse than it is. The cord, if compressed slowly over time can take a lot of compression. I had no idea I had the same problem until I had an MRI and my cord was squeezed down to half it's normal thickness and pushed up against the back of the canal. I was considered moderate to severe compression and you are mild...so you are not in danger right now.

    But you also have more bone spurs and between the disk bulge and the bone spurs, they have blocked up the holes(neural foraminal narrowing) on both sides of C6-7 to a moderate degree...one step below the worst(severe). Here is your main pain/numbness maker.

    The C5 nerve is felt on the outside of the upper arm. C6 is felt on the outside of the lower arm and down into the thumb and index finger. C7 is felt in the middle finger, back and front of the hand. but the nerves still travel through the rest of the shoulder and neck and pain can be felt from them there as well.

    From my experience and many of those here, most spine docs will not operate until you hit the severe level of nerve compression. But numbness in those fingers means you may be starting to reach the severe level. Numbness can be a sign of the nerve having trouble surviving the compression and so the doc may feel it's time based on your symptoms. Even if the MRI says moderate, your symptoms say it's worse. the doc may order an EMG/NCS (electromyelography and nerve conduction studies) to see which it is or he/she may just go base their decision based on your symptoms.

    Is there a way to avoid a fusion...yes. There is a new surgery called a laminoplasty that opens the back of the spinal canal and reshapes the bone and then replaces it, doubling the size of the canal, allowing the cord the cord to move away from the disk. In addition, they open the foramen(holes for the nerves)and then they can also move away from the disk and bone spurs. However, it is a new surgery and you find someone who does it. But you have time to look.

    From experience, you should always get a second opinion and even a third. You want a surgeon, either ortho or neuro who does nothing but spine surgery. You don't want a neuro who does brains and spines or an ortho who dies spines and knees. Spines and only spines. This is an extension of your brain and you want the best specialist you can get.

    Most docs will probably suggest an ACDF...the standard fusion surgery done from the front of the neck to remove the bad disk and fuse together the vertebrae on either side of the missing disk. It's up to you and the doc you chose whether you have the standard or the new surgery. Since they can't do a laminoplasty on C7, you might be better off with the ACDF.

    I hope this helps and know others will be along to give you more support.

    hugs........Jenny(fused C3 to T1)

     
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    Old 03-15-2012, 06:25 PM   #3
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    Re: New here... please help me understand MRI

    At least according to the radiologist, you don't seem to have much of a problem. I see a lot of "mild" and a little "moderate".

    Still, if I were looking for the source of index/middle finger numbness, I would look to the C7 nerve root, where it leaves the cord at the C6-7 level. Lo and behold, you have several problems there. "Moderate" bilateral foraminal narrowing doesn't sound so bad, until you consider that "moderate" is only one level below "severe", and the radiologist may have been ambivalent about which adjective to use. Also, your cord is "mildly indented" at that level. I'm not sure "mild" should ever be used to describe an indentation of the spinal cord. Indented is indented.

    I've concentrated on the finger numbness, as that's a marker for radiculopathy. I really don't know about the arm and shoulder pain. HOPEFULLY, that's caused by the same problems at C6-7.

    Anyway, a surgeon will see all this on your images and probably figure it all out. A C6-7 ACDF might be called for (remove the disk and osteophytes and fuse the C6 to the C7), or he may have an idea for less invasive surgery, or he may want to try other things, first.

    I very, VERY strongly advise getting more than one opinion, if you can, though.

    Last edited by WebDozer; 03-15-2012 at 06:28 PM.

     
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    Old 03-16-2012, 09:33 AM   #4
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    Re: New here... please help me understand MRI

    Thanks so much Jenny and WebDozer! Itsgod to hear you both say some encouraging things...at least some of this isnt as bad as I imagined. I jus cant get past the spinal cord indention part. The thought of that keeps coming to mind and just the thought causes me anxiety. I suffer with anxiety anyway so this has been a nightmare for me!
    I dont know where to begin to get more opinions. I dont have to have referralwith my insurance. I do know the neurosurgeon the ortho dr sent me to only takes patients with referrrals you cant just call for an appointment. Are most neurosurgeons like that too? Im in Nashville and Im sure Vanderbilt has great surgeons bit how do yo know where to begin to find one? Also the dr im seeing is Dr Vaugn Allen. he has his own surgery center at a very good hospital here in Nashville but not at Vanderbilt. Its called the Howell Allen Clinic. I googled it and there is quite a bit of info on his site. If either of you have the time would you please look at his site and give me your opinions... he has all his credentials on there. I do know he wentg to school at Vanderbilt for neurosurgery.

    Is this something that will only get worse? How much time would I be able to put this off because Im and terrified of this surgery!!! Again, thank you sooo sooo much for all your replies!

     
    Old 03-16-2012, 09:46 AM   #5
    Kym617
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    Re: New here... please help me understand MRI

    oh and also the numbness didnt start until after I had the MRI. when i went fot the mri i as having debilitating pain in my shoulder and right arm. it was in the upper and lower arm and just a little in the wrist area... then about a week later the numbne startd and it continued to get worse since. I was also wondering.. if I try to do householdthings or even get out of the house for a while I niotive my arm pain gets bad, if im resting and doingnothing for a few days it gets alot better and i only have shouoder and neck pain. Does that mean that when I am active Im causing it to indent the cord more? should I try to do less until I see the NS? Im so scared its going to suddenly get worse and be paralyzed. Is that possible? Im sorry for all the qeustions Im a basket case over all this.. I ws fine went to Phoenix came home and life as I knew it was gone! Ive been out of worksince the 20th of February!

     
    Old 03-16-2012, 09:58 AM   #6
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    Re: New here... please help me understand MRI

    << Does that mean that when I am active Im causing it to indent the cord more? >>

    I have never heard of that being the case. I would, however, avoid anything that puts undue pressure on the neck, such as some yoga postures. Everyday stuff should not be a problem.

    Some of us here (me included) have had indented - even badly indented - cords for years before doing anything about them.

    Keep in mind, of course, that I'm just an amateur, and my opinion should not substitute for that of a professional.

     
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    Old 03-16-2012, 10:17 AM   #7
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    Re: New here... please help me understand MRI

    First, let's talk about the difference between nerve compression and cord compression. When you have a compressed nerve, it causes pain and the other symptoms you have down the arm. But cord compression does not. It causes symptoms anywhere in the body BELOW the level of compression...so anywhere below C7 it will show up...most likely in the toes or legs. You've probably heard that the brain itself doesn't feel any pain because it has no nerve endings...same with the cord..it doesn't hurt. So you get problems like numbness or muscles not working right...signs of very early paralysis. I had numb toes, my leg muscles were very stiff and some days I could only take baby steps, I was losing co-ordination(walked like a drunk when I could walk)and balance. Since I had cord compression at C4,5 and 6, I also had arm symptoms...something called Clumsy Hand Syndrome. I'd drop things I thought I was holding on to, had trouble signing my name, was losing fine motor control of my hands. Cord compression makes big changes over a wide area.

    Nerve compression gets very nerve specific. You have numbness that goes to a particular nerve, and pain that follows that nerve through the limb. Specific reflexes are affected and they can be less or more than normal. Because a spinal nerve does feel pain, pain is one of the first symptoms followed by numbness once it gets worse where as with the cord, numbness may be the first sign.

    To a spine surgeon, pain really doesn't mean much. A nerve has to be alive to hurt so they look for signs of a nerve that is in danger...numbness, tingling, pins and needles, muscle weakness. So concentrate on the signs that the docs are looking for....if you complain of only pain they send you to pain management.

    But do realize that surgery is not without risk as well so they wait until you show those signs of nerve damage to go in.

    I know Webdozer doesn't like any signs of cord compression but I had a lot of it and got everything back after surgery. The normal cord is about 10-12mms in diameter and I was down to 5-6mms at C6 and 7-8mms at C5 and 4. I woke up with all numbness and weakness and muscle dysfunction, gone. Your MRI didn't give the cord dimensions so ask the neurosurgeon.

    But I saw 4 spine docs prior to surgery and 3 said I needed surgery and 1 said I could wait longer.....so even a cord compressed to half thickness is not enough for some docs to justify surgery. He went by how I was at 9am...and I wasn't bad first thing in the AM. But the others all saw me late in the afternoon to get a better assessment. Nothing worked well by then...important to remember when you schedule appointments...if you are worse late in the day...make your appointments for then. I didn't know that when I saw that one that said no to surgery. But my neurologist said I needed surgery ASAP and I totally trusted her....she clued me into going late in the day.

    So the cord can take a lot and it does frighten many but your doc is the best one to assess how well it is doing with tests and a careful inspection of your reflexes....they can really be valuable in assessing the problem.

    So if you don't have any lower body symptoms, your cord is okay.

    I'll see what I can find on your doc.

    hugs............Jenny

     
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    Old 03-16-2012, 10:42 AM   #8
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    Re: New here... please help me understand MRI

    On the subject of cord compression, let me offer my opinion, which is uneducated, but I hope benefits from at least a little common sense.

    The spinal cord is a bundle of nerves. These nerves have the POTENTIAL to be exquisitely sensitive to pressure. Maybe some nerves are more sensitive than others. Maybe some are more sensitive to pressure from the right, or the left. Maybe some will be more sensitive to an acute indentation, and others more sensitive to a general flattening extending over a longer range. Maybe some will be immediately sensitive, and others take time to react.

    I very much doubt that much of the above has been determined one way or another by modern medical science.

    So, if you have two groups of 100 people, with Group A having 50% indentation and Group B having 10% indentation, I am SURE that, ON AVERAGE, Group A will be worse off than Group B. However, I very much doubt that all 100 in Group A will be worse off than all 100 in Group B. This is a roundabout way of saying that not all indentations are created equal, and not all people may be equally affected by indentations that may appear to be equal. As Jenny has said, severe indentations can be practically asymptomatic. I would add that I believe much less severe indentations CAN be severely symptomatic.

    A number of people have posted here with symptoms that certainly sound like those caused by cord compression. Their radiologists' only speak of "mild" indentation, or "flattening", or of the cord being "touched". While that sounds pretty harmless, I would START with the symptoms. SOMETHING is causing them. While the cord may not be the cause, anything less than a completely unaffected cord should at least be considered as the cause.

     
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    Old 03-16-2012, 10:59 AM   #9
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    Re: New here... please help me understand MRI

    I agree Web...and that is why it is so important for everyone to know what to look for and stop getting caught up in the pain cycle. We think because it hurts, it must be bad but with spinal cords, it's numbness and tingling and muscle dysfunction ANYWHERE in the body that is so important.

    One of the interesting things is that the toes tend to be one of the first symptoms of cord compression yet the nerve fibers for the toes are in the center of the cord(got this from my primary(MD,PhD) who was a researcher on this). Apparently the pressure is transmitted inward and affects the inner nerve fibers over the outer ones that are bring directly compressed. Maybe that is because when there is cord compression, there is usually pressure from being pushed against the canal wall at the same time so you get pressure from both sides. Anyhow, my doc said no one quite knows why this happens only that it does.

    Anyhow, the doc that didn't operate on me said he waited until the chances of paralysis from the surgery itself(about 3%) matched the chances of you having paralysis spontaneously occur....which he said was when the cord got down to about 4mms. We had someone here who was down that far(Baybreeze...are you still around?) and she had symptoms similar to mine and was still waiting for surgery...so this doc wasn't alone with his ideas. However, when 3 of 4 say do it now, I did it then.

    One more reason why it's a good idea to get at least 2 opinions.

    Jenny

     
    Old 03-21-2012, 05:42 AM   #10
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    Re: New here... please help me understand MRI

    Hi Jenny and WebDozer,

    Again thank you both for taking the time to reply to me. I havent been on here since before the weekend until now. I think I was so upset over all this that I needed to walk away from it and spend time with family. I tried really hard to push it out of my mind for a while... of course its getting closer to time to see the NS so Im begininng to get nervous! I do still have tons of rigth arm pain, shoulder and neck too... howver my arm has definilty progressed since the MRI... i now have numbness in the fingers and hand. and my arm drives me crazy because it itches and I cant feel it when i scratch so I cant get the itchy sensation to go away.

    I was thinking about what you sais about cord compression.. I dont have any numbness anywhere except teh fingers and arm... however intheoast year Ive had issues where my toes felt asleep.. I thought it was a circulation problem(yes im a smoker, I know I know) and Ive had issues where I had balance problems when walking...some mild dizzy episodes(notmuch) and once last summer my entire right side of my face went numb for jsut a few seconds...i thought it was a migraine coming on at the time,only happened once but was weird... should Imention all this toi the NS on Monday? does it sound like symptoms from nerve compression? also Im always so fatiqued.. after surgery did you guys seemto feel better in general? I sure hope so!

    Im really scared to have this surgery but I also know that I cant live like this forever.. pain is bad, numbness annoying and I want to get back to normal!

    I have this gorrible fear of not waking uo from surgery ir waking up aralyzed!
    the 3 weekes of waiting to see the NS have been horrible for me because Ive thought of everything that could go wrong....I just feel that I cant goonlike this yet Im so afraid of not waking up that im too scared to do it!

    thank you both so much for your replies.. when I hear what you have gone through Im amazed at your braveness!!!!

     
    Old 03-21-2012, 01:30 PM   #11
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    Re: New here... please help me understand MRI

    If you get in LOTS of pain, you could go to the ER and they would (I think) refer you to a neurosurgeon.... not sure if this helps, but I've seen it done a time or two. Hope you feel better and get it all figured out without to much trouble.

     
    Old 03-26-2012, 03:48 PM   #12
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    Re: New here... please help me understand MRI..3/26 seen NS today!

    I seen the NS today.. he said I had some nerve damage in arm and fingers.. no reflex in parts of arm... he recommended physical therapy for 3 weeks. He said I have a 50/50 chance of it working and avoiding surgery. He did tell me if therapy makes the pain/numbmess worse to call him because no use in doing 3 weeks of therapy and feeling worse if its not going to work... what do you guys think? WebDozer you read my MRI results, does this sound feasible?


    thanks for anyones thoughts on this in advance!

     
    Old 03-26-2012, 05:28 PM   #13
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    Re: New here... please help me understand MRI..3/26 seen NS today!

    What did the NS do before arriving at the conclusion that you have nerve damage "in arm and fingers" (that is, NOT in cervical spine)? Did he do a nerve conduction study? Or did he just look at the MRI and think that it wasn't bad enough to cause your symptoms, so the problem must be down in the arm?

    Whichever, it's not likely he's going to do anything differently until you've gone through the PT, so why not do it?

    Also, just what surgery did he think would be necessary, on the 50% chance that the PT does not work?

     
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    Old 03-28-2012, 05:35 AM   #14
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    Re: New here... please help me understand MRI..3/26 seen NS today!

    i dont know what surgery... he just said it was a easy fix.. everyone there including hubby seemed to act like well therapy it is.. we will address surgery "if" thqt is where we end up.

     
    Old 03-29-2012, 01:00 AM   #15
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    Re: New here... please help me understand MRI

    I had fairly similar symptoms and a not entirely different MRI report, and my cervical issues were treated successfully with one epidural injection. I had far less numbness, but I was dropping things, like a bottle of shampoo or a salt shaker. I had the cervical epidural last May, and it is still relieving most symptoms. I have a home traction unit, which I use when I have a flare. I know that most folks who post did not get such immediate relief, and I expect that I may need more treatment in the future, as this has been a recurring problem for 20 years, now. But I have had periods of up to five years with no symptoms, and I wanted to share one success story, which may put your mind at ease.

    The epidural may be the "simple" fix to which the doctor is referring; it is typically an outpatient procedure involving an injection of cortisone into the spine under x-ray. Many doctors release you to normal activities the next day, but prefer you to generally rest for a couple of days to allow the injection to work.

    You might ask the doctor about a medrol dose pack -- this is a course of anti-inflammatory steroids that can sometimes help with the inflammation caused by a herniated disc, thereby relieving some of the pressure on the nerves. My doctor tried this out while I was starting PT.

     
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