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    Old 08-03-2012, 04:57 PM   #1
    debob484
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    Help with understanding MRI results, please...

    I've been experiencing severe pain over the last year or so between the shoulder blades, upper back and neck. Toes and ball of left foot numb for 6months, right foot which has been numb for several years due to a lumbar herniation and resulting surgery, numbness seems much worse now in toes, ball of foot and ankle on right. Two middle fingers on right hand numb and tingling for a couple of months. I've been experiencing weekness in my hands which is getting worse by the day it seems, can't open jars, zip lock bags, having a hard time putting on makeup...

    I've been tripping and loosing balance easily, mostly with right foot. Gait is unsteady and worsening.

    I tripped on the landing upstairs, and and fell head first down a flight of stairs on 7/11, hitting my head pretty hard, multiple other injuries but no broken bones.
    Two weeks pass, and the upper back pain gets worse and is pretty much constant. Was on Prednisone at the time for a Rheumatiod Arthritis Flare (newly diagnosed). Didn't help the back at all. Pain relievers (Hydrocodone-Ac 5/325) provides no relief. Dr. refuses to write anything else for pain. My dogs get better treatment than that but that's another thread. Referred me to a pain management clinic, total wait 4 weeks of pure torture from my injurys and upper back, fianally have an appointment scheduled for 8/8. Presently taking Ibuprofen, lots of it (helps a little).

    This week I noticed if tilted my head back or to the right my entire right arm from shoulder to finger tips go numb, weak and feels like it weighs 50 pounds.
    Scared the heck out of me. Doctor wanted me to go to physical therapy but I refused until he scheduled a MRI, they called with the results yesterday along with an apointment with the Neurosurgeon who did my lumbar surgery. Picked up the results today:

    Moderate C4 disc space narrowing with mild vertebral marginal osteophyte formation protruding posteriorly indenting the anteriorthecal sac and contacting anterior cervical cord. Buckling of ligamentum flavum indents posterior thecal sac and ontacts cervical cord posteriorly. AP dimension of thecal sac narrowed down to about 7 to 8 mm in midline. Cord does not appear compressed. Uncovertebral osteophyte formation moderately narrows righ C4 neural foramen.

    Moderate C5 disc space narrowing. Slght posterior displacement of C5 relative to C6. Mild bulging of C5 disc and spondylitic bony protrusion indents anterior thecal sac and contacts anterior cervical cord. Buckling of ligamentum flavum encroches on posterior spinal canal at C5 disc level. Cord appears slightly compressed. Uncovertebral osteophyte formation moderately narrows both C5 neural foramina.

    Mild C6 disc space narrowing. Mild broad-based posterior bulging of C6 disc indents anterior thecal sac but does not contact cervical cord. Uncovertebral osteophyte formation mildly narrows right C6 neural foramen.

    Normal C7 disc.Normal homogeneous intermediate signal in cervical cord. Normal vertebral body hights. Normal marrow signal.

    IMPRESSION:

    1.Moderately severe spinal canal stenosis at C5 disc level with cord compression. Moderate C5 neural foraminal stenosis. Slight degenerative retrolisthesis of C5. Buldging C5 disc and degenerative spondylosis.

    2. Moderate spinal canal stenosis at C4 disc level. Degenerative spondylosis and degenerative disc disease at C4. No cord compression at C4. Moderate right C4 neural foraminal stenosis.

    3. Mild bulging of C6 disc. Mild right C6 neural foraminal stenosis.

    What does it all mean? Does it look like I'll need surgery?

    Thank you in advance,

    Debbie

     
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    Old 08-04-2012, 04:33 AM   #2
    WebDozer
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    Re: Help with understanding MRI results, please...

    I can't answer until later, but in the meantime you might want to look at this thread...

    http://www.healthboards.com/boards/spinal-cord-disorders/853183-cervical-laminoplasty-chronicle.html

     
    Old 08-04-2012, 10:51 AM   #3
    WebDozer
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    Re: Help with understanding MRI results, please...

    << Doctor wanted me to go to physical therapy but I refused until he scheduled a MRI >>

    Good for you!! Weakness in hands, tripping and losing balance... and he didn't want to send you for an MRI? I hope the only time you see that guy again is when you're telling him why you won't be seeing him any more.

    As for your MRI, I think (and, of course, I'm just a slightly-educated but over-experienced amateur) that you have two conditions that put you in a minority of people with cervical spinal problems. So it's important to understand a little about spinal structure.

    In front, you have the vertebral column, with vertebrae and disks alternating. Behind that, there's a sort-of-oblong space - the spinal canal - running longitudinally down the spine. The bones that surround this space on the sides and back are the pedicles, facets and lamina. In the space, there's a membrane - the thecum, or thecal sac - which holds in the spinal fluid. Inside the fluid is the spinal cord.

    BEHIND the spinal canal are ligaments - the ligamenta flava - which run vertically and hold together the horizontal levels of the back of the spine.

    At the level of the C3-4 disk, you have osteophytes (bone spurs) growing off the back of the C3 and C4 vertebrae. These are pushing backward into the spinal canal, indenting the front of the thecal sac and actually contacting the spinal cord.

    Now, this is very important... the radiologist says that the osteophytes at C3-4 are "mild". Radiologists often use minimal/mild/moderate/severe to describe levels of severity, so you can see that "mild" shouldn't be causing a problem. So how can a "mild" bone spur protrusion actually grow back into the spinal canal far enough to push away the spinal fluid and contact the cord? There's only two possibilities that I can think of... (1) the radiologist is misreading the images or (2) you have a condition called congenital spinal stenosis, which means that your heredity dictates that your spinal canal is narrower than it ought to be. This doesn't really matter until things (disks, osteophytes, etc) start protruding into the canal, at which point your lack of leeway means that the spinal cord is more likely to be affected.

    Next, the radiologist says that your ligamentum flavum is "buckled" at this level. I've seen reports of hypertrophied ligamenta (mine) and even ossified ligamenta, but I've never seen "buckled". I suppose that might have happened when you hit your head, but it seems rather extreme.

    Also, at this level, you have osteophytes growing off the uncovertebral joints, which are bony formations on top of the vertebrae that help control slippage of one vertebra on another. The osteophytes are growing into the opening (foramen) on the right side of the spine through which passes the C4 nerve.

    The combination of the osteophytes growing from in front and the ligament buckled behind has reduced the spinal canal down to 7-8mm front-to-back. This is quite narrow. I've seen worse (including my own), but a healthy spinal canal should be twice that size. Nevertheless, the radiologist doesn't think the protrusions into the canal have yet reached the point of affecting the cord itself.

    At the next level down (C4-5, I assume, but this radiologist has his own way of describing which level he's talking about), you have the same conditions, but apparently just enough worse to cause the cord to be slightly compressed.

    Now, attempting to correlate your MRI to your symptoms... actually, someone with your MRI might very well have no symptoms at all. At least according to the radiologist, there isn't anything that stands out as immediately problematic, but it seems that oftentimes correlations are not all that clear. For example, one person can have a seriously indented cord, but no symptoms, while another can have only a mild cord compression and have lots of symptoms.

    The tingling of your two middle fingers is a classic symptom of C7 nerve impingement, but the radiologist indicates no problem at all at that level. This makes me wonder if this isn't due to a cord affect at a higher level.

    As for bending your neck causing right-arm symptoms, it seems to me that the bending might either be causing your ligaments to buckle more, or they're causing the osteophytes in front to push into the foramina.

    Anyway, the surgeon should have a lot to say about all this. I STRONGLY recommend you do two things before you see him:

    1) read up on laminoplasties

    2) get an appointment for a second opinion

    Last edited by WebDozer; 08-04-2012 at 10:53 AM.

     
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    Old 08-05-2012, 10:19 AM   #4
    debob484
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    Re: Help with understanding MRI results, please...

    Thank you WebDozer for your time and thoughts.

    I read up on the buckling of the ligamentum flavum that was reported in my MRI results. From what I understand, it means that it has thickened and lost elasticity. When the ligamentum flavum is stretched and then released it's supposed to tighten back to it's original size/length. In my case it seems the ligament does not return to it's original shape, it remains elongated and sort of folds and contacts the cord.

    I took your advice and read the thread regarding your surgery and recovery so I'm assuming that you are of the opinion that surgery is definately something I need to prepare myself for. I find it pretty scary that your pain increased considerably afterwards. Unfortunately the thread ended and I wonder how you're feeling now and how long it took to feel improvement, if in fact there was improvement?

    I've also read some information on both Laminectomies and Laminoplasties. I really don't enjoy the thought of having a Laminectomy, it's a bit scary having the bone removed and nothing remaining there to protect the cord from trama.

    I have a lot of faith in the surgeon who did my lumbar surgery but checked the Tier 1 Institute web site for the procedures he offers and found Laminectomies with no mention of Laminoplasties. If surgery is recomended, I will be discussing the pros and cons of each. I will also follow your advice and get a second opinion.

    I have to say that I'm definitely concerned about my primary care doctor who was highly recommended by my sister who's been seeing him for several years. In in his defence I'm a brand new patient who had no complaints at my initial visit. I was feeling pretty darn good that day and was a bit nervous seeing a new doctor, I told him I had no current complaints. Two months after my initial appointment I visited him with severe knee arthritic flare, upper back & neck pain and a list of other painful joint symtoms.

    What really really gets my goat is how doctor's eyes glaze over when you mention pain. I haven't had a primary care physician in a few years. I wasn't happy with the staff at my previous doctors office so when she moved to another practice, I didn't follow her. In the relatively few times I've had to see a doctor for various colds or illness since I've visited a local walk in clinic.

    I'm a 55 year old professional woman and definitely don't come off as some sort of druggie. However, doctors automatically assume you're a pill shopper. I've lived on ibuprofen for 20+ years due to ongoing lower back pain and choose to deal rather than seek narcotics. Unfortunately I'm used to living with pain. I tried to tell him this and it seemed that he quit listening from the time I mentioned the dreaded four letter word 'PAIN'. When I do ask for pain meds, which is seldom, it's for good reason. Unfortunately, my new doctor doesn't know me or my history so I'm trying to be understanding about it. In a last ditch effort to remain his patient, I'm scheduling a consultation with him along with my sister who is a long standing patient to set things straight. Hopefully the consultation and the results of all of my previously mentioned issues being documented as valid and painful will show him the light. If this doesn't improve things, I'll be searching for a doctor who listens and treats his patients without immediately jumping to conclusions.

     
    Old 08-05-2012, 10:38 AM   #5
    Ilovemycutedog
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    Re: Help with understanding MRI results, please...

    Sounds like you are on the right path to get a 2nd and even 3rd opinion from Board Certified surgeons...

    To speak about your Primary Care Dr. This is not the type of Dr. you should be seeing for your pain. You need to get an appt. with an actual Pain Management Dr. New laws are being passed in many states where Primary Care Drs., or anyone who is not a PM, have to go through additional training and certification if they are to prescribe any type of opiate pain medication. Both the state and the DEA monitor every physician and patient who is getting opiate prescriptions.

    A Primary (or GP) is not trained in PM and most of them are not comfortable with that type of medication nor do they want to get involved with a patient that is most likely to have chronic pain and not acute pain treatment. It's like asking them to specialize with heart or kidneys....they would refer you to the appropriate Dr. for medication and treatment. It's the same with pain mgmt.

    So I would not try to pursue that avenue any further to get appropriate pain mgmt. from that Dr. I would be they would be happy to refer you to a PM (if you need a referral). You can look through the list of PMs that your insurance covers.

    You want to look for a PM that provides comprehensive pain management. This includes medicinal and non medicinal treatments. The key is to not ask over the phone if they prescribe medication.

    You just need to ask if they provide a comprehensive approach using all modalities.

     
    Old 08-05-2012, 11:02 AM   #6
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    Re: Help with understanding MRI results, please...

    << I took your advice and read the thread regarding your surgery and recovery so I'm assuming that you are of the opinion that surgery is definately something I need to prepare myself for. >>

    I do. Of course, that's just my amateur opinion.

    << I find it pretty scary that your pain increased considerably afterwards. Unfortunately the thread ended and I wonder how you're feeling now and how long it took to feel improvement, if in fact there was improvement? >>

    The PTB determined that that thread was a "blog" and cut it off. Actually, my pain improved immediately and dramatically shortly thereafter. While the pre-op symtoms came back, they went away again. New symptoms (chills) came on, then went away. Fourteen months later, I'd say the op was a success, but you never really know, with these things.

    << I've also read some information on both Laminectomies and Laminoplasties. I really don't enjoy the thought of having a Laminectomy, it's a bit scary having the bone removed and nothing remaining there to protect the cord from trama. >>

    Supposedly, that's not so much of a problem, as there's a thick layer of muscle back there, but I'm inclined to agree with you.

    << I have a lot of faith in the surgeon who did my lumbar surgery but checked the Tier 1 Institute web site for the procedures he offers and found Laminectomies with no mention of Laminoplasties. If surgery is recomended, I will be discussing the pros and cons of each. I will also follow your advice and get a second opinion. >>

    And a third, I would hope, including one from someone who does laminoplasties. If you're within range of LA or Boston, I will give you a name. I think that someone here - besides me and Jennybyc - reported on a laminoplasty, but I don't remember who.

    I could well be wrong, but I think that laminectomies are now the province of older surgeons who've never bothered to learn laminoplasties. Also, there are lots of surgeons who will tell you that only an ACDF is the answer for you, because they only do ACDF's.

    << I have to say that I'm definitely concerned about my primary care doctor who was highly recommended by my sister who's been seeing him for several years. >>

    From your symptoms, he should have ordered an MRI (in my amateur's opinion).


    << I'm a 55 year old professional woman and definitely don't come off as some sort of druggie. However, doctors automatically assume you're a pill shopper. >>

    Well, in their defense, docs have to be very careful about this kind of thing, for their own protection. The DEA is watching. Also, docs know something that a lot of their patients may not know, which is that aging is a process of getting used to increasing levels of pain and disability, and there's not much they can do about it. And there's a lot of hypochondriacs out there.

    One thing that just occurred to me. If you read the literature on laminoplasties, you'll see that they were largely developed in Japan, and possibly Korea, and were widely practiced there before gaining what little popularity they have in the USA. I think that MAY be because of a hereditary propensity in that part of the world for hardening (ossification?) of the ligamentum flavum.

    Last edited by WebDozer; 08-05-2012 at 11:12 AM.

     
    Old 08-05-2012, 01:05 PM   #7
    debob484
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    Re: Help with understanding MRI results, please...

    Thank you for your response Ilovemycutedog,

    My apologies for not making myself more clear, I do have an appointment scheduled with a Pain Clinic on Wednesday.

    I've been out of the loop regarding these new proceedures, it's been several years since I've needed actual pain meds or had a primary care physician. The last time I required narcotics for pain was 4 or 5 years ago when I tripped and fell breaking my wrist in two places. The ER prescribed pain meds which worked in the week I awaited an appointment with an orthopaedic surgeon who fixed it. She also prescribed pain meds for the week following my surgery.

    I was surprised to learn that we actually have a pain management clinic in our small town. I thought, after he mentioned it, that I'd probably have to commute to a large city. I have not personally contacted this clinic, the doctors staff set up the appointment. I assumed from what I have read over the internet that they all offered multiple therapies for pain management. I plan on going there with an open mind and am willing to do just about anything non-invasive they suggest. Waiting to hear what the surgeon has to say before participating in any invasive stuff.

    Still, I find it inhumane that after falling down the stairs which resulted in multiple injuries and having severe, debilitating pain that was not being managed at all would have qualified me for a med that would help on a temporary basis. Instead I was allowed to suffer nearly unbearable pain for two weeks. After finally being able to go to a follow-up appointment, I did not mention pain meds as my injuries were finally made tolerable with ibuprofen, I simply mentioned a portable device similar to one I've been treated with in the past at my Chiropractors office for the ongoing lower back pain. I wondered if he could prescribe one. It was at this point that I was referred to the pain clinic. Ideally, I prefer fixing the problem or using a device to help manage the pain rather than the 16 to 20 ibuprofen a day that are probably destroying my kidneys or narcotics which cause their own miserable side effects and dependency.

    My real complaint with my current doctor is him not listening to my description of symptoms relating to spinal issues after hearing that I have had lower back pain for years (for which I took ibuprofen) and was currently experiencing upper back, joint pain, numbness in my feet and tingling in my fingers. This complaint began prior to my fall and at no time did I ask for any kind of meds. As a matter of fact I have not mentioned pain medication at any time other than the day following my accident. Then, as my symptoms continued to multiply with the numbness in my right arm and hand from turning my head, he only suggested physical therapy.

    Bottom line, once this doctor received the radiologist report on my neck that stated that I did not have rheumatoid arthritis in my neck but I did have osteoarthritis & severe degenerative disc disease he should have added two and two together and ordered an MRI. However, I feel that he labeled me from the get-go, ignored my complaints and documentated evidence which led to the obvious conclusion (in my eyes) that there might actually be a real, not imagined or made up, problem.

    Had I not insisted on the MRI prior to any type of physical therapy he wanted me to participate in, I would not have had one. I would not be on my way to a surgeon this coming Thursday, and I would be looking at possible permanent nerve damage or further disability due to a delay in treatment.

    Sorry, I know I'm sounding a bit defensive but it's all been very upsetting. It seems that I'm literally falling apart with all of the bad news, in regards to my health, I've received in the last month.

     
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