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  • PLEASE help with MRI results!

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    Old 06-05-2012, 06:43 PM   #1
    e911indy
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    PLEASE help with MRI results!

    I've been referred to a neurosurgeon reference my MRI results, however, the earliest appointment I can get is not for 4 more weeks. My treatment to date has been medrol dose pack (no effect) and physical therapy-which they are hesitant to do much at this point until I see the neurosurgeon? I am not currently on any pain medicine, I was hoping the medrol would help. I did leave my doctor a message today asking for something for the severe pain. If anyone can help with the results of the MRI below, I would greatly appreciate it.



    MRI cervical spine without contrast


    Findings: c2-3: there is slight spurring and bulging on the left which at most slightly lattens the thecal sac. I do not believe there is any significant mass effect.

    c3-4: there is fairly marked disc disease with spurring and a bulge. these changes cause near complete effacement of CSF space with moderate central canal and let neural foramen narrowing. there is no spinal cord flattening or deformity.

    c4-5: there is airly prominent disc disease with spurring and a bulge. these changes also cause complete effacement of CSF spaces without deformity of the spinal cord. there is at least moderate central canal and right greater than let neural foramen narrowing.

    c5-6: there is near complete loss of disc height and signal. there is spurring and a bulge. these changes cause complete effacement of the CSF spaces with at least moderate central canal narrowing. There is no spinal cord lattening or deformity. there is, however, severe right greater than left neural foramen narrowing.

    c6-7: there is moderate loss o disc height and disc signal. prominent bulge and spurring. overall, there is mild to moderate narrowing of the central canal and neural foramina.

    c7-t1: Slight bulge and spurring without significant mass effect.

    there is mild straightening normal cervical lordosis. there is mild levoconvex scoliosis centered at the cervicothoracic junction. no definite acute bony changes appreciated. limited evaluation of the posterior fossa and paraspinal regions are unremarkable.



    IMPRESSION:
    1. prominent multilevel spondylosis as better described above which is the likely cause of mild straightening of the normal cervical lordosis and mild levoconvex scoliosis.

    2. although there is at least moderate multilevel central narrowing as described, I am not convinced there is any definite spinal cord flattening or deformity.

    3. there does, however, also appear to be airly marked multilevel neural foraminal narrowing which is felt to be fairly severe and eccentric to the right at c5-6 which is greatest level. however, there is fairly prominent and at least moderate narrowing of the neural oramina at several other levels as described as well.


    Is this something that would most likely warrant surgery? I've been in so much pain the past couple of months, which is new for me, and just hoping this can be resolved soon.

    Thank you in advance for any and all help!

     
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    Old 06-05-2012, 07:36 PM   #2
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    Re: PLEASE help with MRI results!

    I see this all the time-people come here and ask non medical people to interpret an MRI and give their non medical opinion on whether they need surgery. Then they spend the next 3 or 4 weeks getting all worked up and then their surgeon tells them to try the conservative route first.

    The only person that can tell you if it warrants surgery is your neurosurgeon. People can give you their opinion due to their past experiences but like I said, the only opinion that matters is your neurosurgeon's. After all, he is the one that went to medical school

     
    Old 06-05-2012, 08:19 PM   #3
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    Re: PLEASE help with MRI results!

    e911... You are in a tough spot, having to wait four weeks for even one opinion. There are surgical options that come to mind, and this first guy may prefer one of them, or may prefer something non-surgical.

    I would VERY STRONGLY recommend getting multiple opinions. From reading your MRI, it strikes me that different surgeons might have very different approaches to your case. Even if they all favored surgery, they very likely would not agree on the nature or extent of the surgery. Unfortunately, one surgeon might recommend one particular option, but for the wrong reasons, such as not knowing much about, or not being experienced in, better options.

    Take a moment, though, and consider your situation. If you're in great pain, and becoming increasingly anxious, and then you have to wait FOUR WEEKS, you will be very likely to immediately accede to whatever this first surgeon recommends, which you might later regret.

    At that point, you won't want to wait many weeks more for other opinions. That's why I would very much recommend lining up TWO additional appointments. You could make them three consecutive days, or even three consecutive hours, if you think you can deal with that. The point is, you need those extra opinions, and you need to line them up now, or the pressure to just accept whatever you hear first will be overwhelming.

    If there's anything you don't understand about your report, I (or others) will try to explain, but I don't want to go into a long explanation if you don't need it. If you do want that explanation, though, could you write a little about your symptoms, in particular their locations (right, left, shoulder, hand, which fingers, etc)?

    Last edited by WebDozer; 06-05-2012 at 08:23 PM.

     
    Old 06-05-2012, 08:29 PM   #4
    e911indy
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    Re: PLEASE help with MRI results!

    Thank you, Webdozer, very much for that sound advice. I have to agree completely. My symptoms are pain from the base of my skull on the right side of my neck down to my bicep. The top of my shoulder/bicep area is the most painful with a sharp aching. The pain is constant and unrelenting. I'm not experiencing a lot of numbness. As far as that goes if my right arm is in a certain position it will immediately have that 'fall asleep' feeling. As far as I understand from the MRI there is at least some bulging in all of the cervical discs? I'm not clear on what "effacement of CSF" means, however.

    Again, Thank you for taking the time to reply and I will definitely not take any decision regarding surgery or other options lightly.

    My best,
    Beth

     
    Old 06-05-2012, 08:56 PM   #5
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    Re: PLEASE help with MRI results!

    Effacement - Running vertically inside the bony cage of your spine is your spinal canal. The canal is lined by a membrane called the thecal sac, which holds in the spinal fluid (CSF). Suspended within the fluid (ideally), is the spinal cord. So one of the functions of this fluid-filled space (maybe the only function... I don't know), is to provide a cushion for the cord, some room for error, as it were. Various things (disks, bone spurs, swollen ligament) can intrude into the spinal canal without actually impinging on the cord, at least to a point.

    When something pushes far enough into the canal, though, it pushes away the CSF surrounding the cord, starting with one side (usually the front), then eventually on all sides. The CSF is said to be "effaced", then, meaning "no longer observable". The radiologist considers that your CSF is completely effaced at two levels, meaning that he can't see any CSF inside the canal at those levels. This means that your room for error is gone, and further intrusions into the canal will affect the cord itself, although the radiologist believes that the cord is not yet affected, or at least does not appear to be.

    Your neck pain and arm symptoms COULD be explained by the right-side foraminal narrowing. If the foramina at those levels are sufficiently occluded, the nerves will be squeezed (radiculopathy). The fact that the radiologist happens to see the worst foraminal narrowing on the same side where you have the worst symptoms is support for that.

    Last edited by WebDozer; 06-05-2012 at 08:58 PM.

     
    Old 06-05-2012, 09:21 PM   #6
    kenzibenzi
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    Re: PLEASE help with MRI results!

    Quote:
    Originally Posted by WebDozer View Post
    Effacement - Running vertically inside the bony cage of your spine is your spinal canal. The canal is lined by a membrane called the thecal sac, which holds in the spinal fluid (CSF). Suspended within the fluid (ideally), is the spinal cord. So one of the functions of this fluid-filled space (maybe the only function... I don't know), is to provide a cushion for the cord, some room for error, as it were. Various things (disks, bone spurs, swollen ligament) can intrude into the spinal canal without actually impinging on the cord, at least to a point.
    WOW! This just cleared up so many things for me! Thanks for the awesome explanation WebDozer!

    Now back on topic...
    I too had to wait a very long time to see my spine surgeon. It's enough to really test your anxiety level. Read around on these posts and get familiar with some of the terms used in your MRI report and hopefully that will set your mind at ease until you can see the doc. From my personal experience, the wording is sometimes scarier than the problem, at least it is that way for me. I do hope things work out for you and it's nothing serious. I've never had surgery on my neck, trying to avoid it at this point by doing the conservative treatments right now. Keep us posted on your progress, and don't be shy, there are some very nice people on these boards who will totally understand you. Take care, Kenzi.

     
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