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    Old 08-08-2012, 07:33 AM   #1
    gav_73
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    Ventral cord deformity and narrowing... among other things

    Hi,

    I've had neck issues for awhile and my recent MRI showed "impression on ventral cord" and "ventral cord deformity" in several areas, as well as "narrowing" with AP measurements of 6.7mm in some areas, and 9.5mm in others. I wish I had the radiologist's report in front of me. I am used to reading MRIs but I'm not sure what all this means, "deformity" and "AP dimensions" and "narrowing." There is no mention of stenosis or cord compression, but if I don't have that, what does narrowing and "impression on the ventral cord" mean? My doc said the report makes it not seem as bad as it is. But when I read it it sounds bad to me. However, I am not sure what these words mean exactly.

    Any thoughts? I'll post the full impression later once I get home from work.

    Thanks!

     
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    Old 08-08-2012, 08:35 AM   #2
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    Re: Ventral cord deformity and narrowing...among other things

    Narrowing, impression, and deformity mean the same as compression in this sense- something, most likely bulging or herniated discs are pressing on the spinal cord in neck. They give the actual measurements from front to back (AP) of cord so the degree of compression can be appreciated. Cord compression in the neck could cause pain as well as motor weakness of muscles at any level below the neck. The actual report will help clarify further. Average cord thickness in neck is between 7.4mm and 8.8mm, depending on the level.

     
    Old 08-08-2012, 09:20 AM   #3
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    Re: Ventral cord deformity and narrowing...among other things

    narrowing = stenosis
    AP = front-to-back

    When you get the report, post it, and say a little about your symptoms, and I will give you my expert amateur's opinions (or should that be "amateur expert's"?)

     
    Old 08-08-2012, 09:42 AM   #4
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    Re: Ventral cord deformity and narrowing...among other things

    Thank you so much for your quick reply! I am kicking myself for not having the report with me - GRRRR! As far as my symptoms, they are many. I have simultaneous right face-neck-arm-fingertip paresthesias (tingling, numbness, weakness) for several years that come and go. The pain is also intermittent, and is more of a stiff crick in the neck that comes suddenly and can last for weeks or months. When the neck hurts, the paresthesia symptoms go crazy. I start getting these shock-like sensations that happen for about 1-2 seconds, but they can happen repeatedly up to 100x per day, driving me totally insane. They seem to come with ANY movement of my head. The stumper is the face tingling involvement. No one can seem to figure out why my face would be involved, but it is. I also have some motor dysfunction also, such as hyper-reflexia, tremors, spastic movements in my head and hands, inability to control certain movements when holding my head up, stuff like that. But the MRI shows no MS lesions or stuff that could indicate some underlying illness (I had an MRI of my brain too, mostly normal). Ugh, who friggin knows...

    I have something noted on just about every point on my cervical MRI except for C1-2, C-2 on down to C-7 seems to be all jacked up. I do remember a mention that there "do not appear to be any signal changes", but that is only noted on my C-1-2. There was some mention of osteophyte protrusion around C-3 at 3.5mm? Something like that. There was no mention of herniation anywhere, but several things were stated about dissection at all levels, narrowing, deformity, osteophytes, bulging, impressions on the cord, AP dimensions, kyphosis, thecal sac, etc. I wish I had the dang report!!!!

    What's strange is that every doctor that looks at my cervical MRIs is surprised that I'm not in MORE pain than I am. While I do have pain, it's really the numbness, weakness and tingling that's making things difficult to deal with. My concern is permanent nerve damage. This Friday I went in and had a C-6 nerve root block and who knows what happened there. I woke up in more pain than ever before, and NEW pain on the left side. One thing the anesthesiologist said after the procedure is that "it looks really bad in there..." and sent me home with a bunch of pain meds. He also said I had what sounded like a strong reaction during the procedure where my body seized up while I was unconscious and that he had already reported to my orthopedic surgeon about it before I even woke up. What stinks is that is about all I know. My OS is out of town, my OS's PA doesn't have any calls from the anesthesiologist noted in the system from the call, and he was surprised that I have MORE pain than less. So far I haven't heard back from anyone about anything, as they said on Monday that they were "looking into it." What the heck???

    Also, I'm a little confused as to what AP dimensions they measured. Does it mean the dimensions of the spinal cord only, or from front to back of the whole spinal canal? I read that the average "AP dimensions" are 12-17mm, but I guess that's for the whole thing. If the spinal cord itself was measured, it doesn't seem that bad to be at 6.7, but the other AP dimensions at the C-7 level are 9.5mm but still mentions narrowing. However, according to your averages, the 9.5mm goes outside of the highest range. Wouldn't that indicate that it's a larger space than normal? I guess my confusion lies in what the heck they measured, because it could make a difference in the severity of the narrowing. Know what I mean? If the spinal cord itself was 6.7mm that doesn't seem so bad. But if the spinal canal or whatever the larger measurement average was only 6.7mm, that seems pretty bad. Ugh, I hate not having answers. I know you guys can only help so much with such limited info...but your knowledge about such things is greatly appreciated.

    Last edited by gav_73; 08-08-2012 at 10:02 AM.

     
    Old 08-08-2012, 10:04 AM   #5
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    Re: Ventral cord deformity and narrowing...among other things

    OK, when you get a chance (I will be out most of tomorrow). If you are near LA or Boston, I can give you a name.

    FWIW, I was told that my cervical spine was "a mess", but I'm still functioning. Here's link to my MRI...

    http://www.healthboards.com/boards/spinal-cord-disorders/904688-my-pre-laminoplasty-mri.html

    << I'm a little confused as to what AP dimensions they measured. Does it mean the dimensions of the spinal cord only, or from front to back of the whole spinal canal?>>

    He should specify if he's referring to the cord or to the canal, but if he doesn't, I'd assume canal.

    Last edited by WebDozer; 08-08-2012 at 10:06 AM.

     
    Old 08-08-2012, 10:19 AM   #6
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    Re: Ventral cord deformity and narrowing...among other things

    Thanks so much for linking me to your MRI. Mine has a lot of information as well (although I don't have it and I'm leaving to go out of town today as well, ARGH - I'm in the Dallas area, btw), but the terminology used in mine (to me) makes the findings sound insignificant and benign. I guess that's what my OS meant when he said it was worse than the radiologist's report made it sound. Like not mentioning "stenosis" specifically but using "narrowing" for her impressions; or using "impression" on the cord rather than "compression", which is what most use, if that's what she meant. Also, using words like "some" instead of a mild, moderate, severe scale. And not mentioning what AP dimensions were measured exactly drives me crazy. I am usually pretty good at reading these things if they use typical terminology that you can look up and know exactly what they mean. But I get different info when I look up some of the things, like the AP dimensions, etc. I'll post the report as soon as I have it. Any thoughts on all of these symptoms? With the little information that I've given you, what is your "expert" opinion on the severity of my issues? Should I be worried at this point and consider surgery, or should I stay on a "wait and see" status until something worse happens? Do you think I am at risk of something permanent happening? And I know you can only give your impression and aren't a doctor, you don't have to go through the whole spiel LOL

    Also, what are your thoughts on what the heck could've happened during my injection? Part of me thinks it wouldn't be that unusual for my body to have a physical reaction to stinking a needle in a nerve, even if I was asleep. But the doctor acted like it wasn't normal. Of course he provided no more info other than telling me he called my doc.

    Last edited by gav_73; 08-08-2012 at 10:23 AM.

     
    Old 08-08-2012, 10:42 AM   #7
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    Re: Ventral cord deformity and narrowing... among other things

    I dunno... your MRI sounds pretty bad to me. "Stenosis" and "narrowing" mean the same thing, and something can't be "impressed" without being "compressed".

    Even so, you might want to send your MRI to another radiologist. I'll give you the name of the guy who did mine, if you want. I don't know if he takes mail-in's, but I don't see why he wouldn't.

    << I have simultaneous right face-neck-arm-fingertip paresthesias (tingling, numbness, weakness) for several years that come and go.>>

    Always simultaneous? Which fingers?

    <<The pain is also intermittent, and is more of a stiff crick in the neck that comes suddenly and can last for weeks or months.>>

    Where, in relation to your hairline?

    << When the neck hurts, the paresthesia symptoms go crazy. I start getting these shock-like sensations that happen for about 1-2 seconds, but they can happen repeatedly up to 100x per day, driving me totally insane. They seem to come with ANY movement of my head.>>

    Where does the "shock" go? Arm? Leg?

    << The stumper is the face tingling involvement. No one can seem to figure out why my face would be involved, but it is.>>

    I suppose the C2-3 level might be involved in that. Look up "dermatome + C3" and you can see that both the C2 and C3 nerves could be at fault.

    << I also have some motor dysfunction also, such as hyper-reflexia >>

    Knee? Elbow? Both sides?

    << tremors, spastic movements in my head and hands, inability to control certain movements when holding my head up, stuff like that. >>

    You mentioned kyphosis. Do you have a kyphotic cervical spine?

    << I have something noted on just about every point on my cervical MRI except for C1-2, C-2 on down to C-7 seems to be all jacked up. I do remember a mention that there "do not appear to be any signal changes" >>

    That's good....

    << There was some mention of osteophyte protrusion around C-3 at 3.5mm? Something like that. >>

    That ain't small...

    << There was no mention of herniation anywhere, but several things were stated about dissection at all levels, narrowing, deformity, osteophytes, bulging, impressions on the cord, AP dimensions, kyphosis, thecal sac, etc.>>

    But no gremlins? Something to be thankful for. And that's "dessication", and is par for the course if you are over 50.

    << What's strange is that every doctor that looks at my cervical MRIs is surprised that I'm not in MORE pain than I am. While I do have pain, it's really the numbness, weakness and tingling that's making things difficult to deal with. >>

    It's good that you're not in much pain, but doesn't mean that much. I've had three different surgical operations, and none was preceded by any pain worth mentioning.

    << My concern is permanent nerve damage. >>

    I'm afraid that's an appropriate concern...

    << My OS is out of town, my OS's PA doesn't have any calls from the anesthesiologist noted in the system from the call, and he was surprised that I have MORE pain than less. So far I haven't heard back from anyone about anything, as they said on Monday that they were "looking into it." What the heck??? >>

    Just be glad you aren't in Canada, or the UK. These interactions that are frustrating you would have MONTHS in between, not days.

    << Also, I'm a little confused as to what AP dimensions they measured. Does it mean the dimensions of the spinal cord only, or from front to back of the whole spinal canal? I read that the average "AP dimensions" are 12-17mm, but I guess that's for the whole thing. >>

    yes

    << If the spinal cord itself was measured, it doesn't seem that bad to be at 6.7, but the other AP dimensions at the C-7 level are 9.5mm but still mentions narrowing. However, according to your averages, the 9.5mm goes outside of the highest range. Wouldn't that indicate that it's a larger space than normal? >>

    if the canal is 9.5, I think that's rather narrow...

    Last edited by WebDozer; 08-08-2012 at 10:44 AM.

     
    Old 08-08-2012, 11:08 AM   #8
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    Re: Ventral cord deformity and narrowing... among other things

    Thanks again for your quick reply!!! I feel badly that I have all these questions without the report. But I'm remembering bits and pieces of the stuff that confused me the most, so at least it's not a total waste of time to discuss :-) So let me run through your questions for me so we can have a meeting of the minds and talk about it.

    <<Even so, you might want to send your MRI to another radiologist. I'll give you the name of the guy who did mine, if you want. I don't know if he takes mail-in's, but I don't see why he wouldn't.>>

    I wouldn't mind at all. I'm scheduled to see a great and highly recommended neurologist in town, but I can't get in until Sept 17, which by UK and Canadian standards is a dream, I'm sure.

    <<Always simultaneous? Which fingers?>>

    If I have the facial paresthesia (always on the right maxillary part of my face), it's always accompanied by simultaneous tingling in the right arm, affecting my ring and pinky fingers, but has happened in my thumb before too. On the other hand I have had the arm and finger tingling without the facial paresthesia.

    <<Where, in relation to your hairline?>>

    Usually on the right side at the base of my neck in between my shoulder blades. Sometimes it is accompanied by shoulder pain on both sides.

    <<Where does the "shock" go? Arm? Leg?>>

    The shock feels like a burst of tingling on the right side of my face, neck, arm and fingers and only lasts for a second. While it feels like it happens simultaneous because it happens so fast, it seems more like it goes from my face down my arm if anything, rather than from the bottom up. The facial paresthesia is in the maxillary portion of my face only, under eye, cheek, and upper lip, down the right side of my neck to my ring and pinky finger tips, all in a matter of seconds but repeatedly and sudden. It stuns me more than anything.

    <<I suppose the C2-3 level might be involved in that. Look up "dermatome + C3" and you can see that both the C2 and C3 nerves could be at fault.>>

    I'll look it up for sure.

    <<Knee? Elbow? Both sides?>>

    I'm hyper-reflexive at wrist, elbow, knee and ankle on both sides, but more prominently on the right.

    <<You mentioned kyphosis. Do you have a kyphotic cervical spine?>>

    Yes, clearly noted on my cervical MRI as one of the first things mentioned. However, oddly it's not mentioned on the impression. (sigh)

    << I have something noted on just about every point on my cervical MRI except for C1-2, C-2 on down to C-7 seems to be all jacked up. I do remember a mention that there "do not appear to be any signal changes" >>

    That's good....

    << There was some mention of osteophyte protrusion around C-3 at 3.5mm? Something like that. >>

    <<That ain't small...>>

    I believe that was noted on my C4-5


    <<But no gremlins? Something to be thankful for. And that's "dessication", and is par for the course if you are over 50.>>

    I'm not, I'm only 39 :-(

    <<If the canal is 9.5, I think that's rather narrow..>>

    I know, and even worse would be an AP dimension of my canal at 6.7mm. The problem is, of course, is if that's my canal or cord measurements. (ugh) Stupid radiologist...

    So in the end you would feel confident that I have spinal stenosis and some cord compression? That's kind of been the criteria by which I've used in the past to determine whether or not I'll consider surgery since my pain isn't unbearable. The nerve and spinal cord damage has always been the utmost concern to me in making that decision. And it appears to be getting worse. My 2009 cervical MRI didn't seem this bad at all, and there definitely wasn't any stenosis or cord compression noted at that time. The bad part is is my husband just quit his job to go to dental school and I am the only bread winner. We have a two year old also. And I just found out that the HUGE corporation that I work for does NOT pay for FMLA! They only guarantee your job back, the minimum the law requires. So if I had the surgery I wouldn't get paid during recovery. Ugh. In that case, I may not even be able to have the surgery if I wanted to :-(

     
    Old 08-08-2012, 11:44 AM   #9
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    Re: Ventral cord deformity and narrowing... among other things

    To me, it's not a question of pain so much as whether or not the cord suffers permanent damage. Supposedly, you can go six months before damage becomes permanent, but I'm sure that's only a very rough guideline. I have some minor permanent damage (myelomalacia) from a problem that was fixed within two months of the first symptoms.

    The second question is whether it's the cord or the nerve roots where they pass through the foramina. When you simultaneously have symptoms from the C8 level (ring and pinky finger) and the C3(?) level (face), then one might suspect the cord up high.

    The neck pain down that far sounds like something else altogether. Maybe a spine problem, maybe "just" muscles.

    Hard to tell without the MRI. Might be hard to tell with it, too.

    My radiologist is Barry Berkowitz, in Van Nuys....

    And yes, I think you should "consider" surgery. Of course, I'm just an amateur with a little bit of self-education, however opinionated I may be.

    Last edited by WebDozer; 08-08-2012 at 11:47 AM.

     
    Old 08-12-2012, 04:36 PM   #10
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    Re: Ventral cord deformity and narrowing... among other things

    Hi Webdozer and friends,

    I'm sorry for the delay in posting the actual report for my MRI. Just got back from business travel and have a two year old. Anyway, I've read it over and over and here it is. Verbatim:

    No definite cord signal alteration or abnormal enhancement is seen in the cervical region. There is cervical kyphosis.

    The craniovertebral junction and C1-C2 level appear within normal limits. No focal enhancing lesions are seen in the cervical spine.

    There is some disc desiccation at C2-C3 with mild facet hypertrophy and arthrosis.

    At C3-C4 there is some disc desiccation. Mild facet and uncovertebral joint hypertrophy is seen, with mild crowding of the exit foramina.

    At C4-C5 there is some disc desiccation. Some mild facet hypertrophy arthrosis is seen. Anterior osteophytes are seen.

    At C5-C6 some disc desiccation is seen. Anterior osteophytes are seen. There is impression upon the central right aspect of the cervical cord by 3.5mm AP X 10mm transverse right posterior paramedian disc protrusion and osteophyte complex. There is some ventral surface cervical cord deformity at the expected emerging ventral root of the right C7 nerve. AP dimensions of the thecal sac measures 7.7mm to the right of the midline. There is moderate narrowing of the right exit foramen constraining the right C6 nerve. No cord edema is seen.

    At C6-C7 there is disc desiccation. Some Anterior osteophytes are seen. There is some edematous endplate change as well. There is some posterior central annular fissuring with disc bulge and posterior central disc protrusion slightly contacting the ventral surface of the cervical cord. AP dimension of the thecal sac measures 9.5mm.

    C7-T1 through T4-T5 disc space levels appear within normal limits.

    IMPRESSION:

    1. Developmental venous anomaly in right cerebellum (from brain MRI)
    2. Disc desiccation and mild spondylosis at C2-3, C3-4, and C4-5
    3. Disc desiccation at C5-6 with ventral right surface cord deformity due to right paramedian disc protrusion and osteophyte complex. There is moderate narrowing of the right exit foramen as well.
    4. Disc desiccation at C6-7 with disc protrusion and spondylosis with mild ventral surface cervical cord contract.

    Well, that's everything. The more I read it with all the "mild" and "moderate" impressions makes me feel like it's not so bad. But then again, the referring doc specifically stated that the report made it sound less severe than it is. So that makes me think it's not so good. Also, the orthopedic surgeon referred me to a neurologist and really didn't want to talk more in depth until I saw the neurologist. So I'm just at a loss. With so many symptoms I feel like there's more going on. But who knows. Thanks for your help and advice!!!

     
    Old 08-12-2012, 06:31 PM   #11
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    Re: Ventral cord deformity and narrowing... among other things

    This radiologist seems to have a way with words. He somehow makes "cord deformity" and "constraining the nerve" sound almost benign.

    Considering that you've had at least two(?) docs indicate that you're in worse shape than the radiologist's report makes it sound, I'm really wondering what another radiologist would say.

    What about the "venous anomaly"? At least it's on the right side, where the worst of your symptoms are.

    Although your cord could be deformed much worse, still, deformed is deformed. One has to expect abnormal symptoms from that. And if it's worse than the radiologist makes it sound...

    Still, nothing to explain facial symptoms, as C2 and C3 seem to be OK. Also, the pinky finger tingling... that's from C7-T1, where he indicates no problem.

    I have to wonder where the kyphosis comes in. Yours is the first MRI I've seen that explicitly states kyphosis. Normally, they will say "loss (or reversal) of normal lordosis". Does "kyphosis" mean it's even worse than "loss of lordosis", or is this just this radiologist's idiosyncratic way of putting it? Seems like kyphosis might put a lot of pressure on those cervical disks, and possibly make them bulge out further than they would when you're supine in an MRI tube.

    All in all, I'm more or less at a loss. Apparently the docs who say you're worse off than the report indicates are looking at the MRI images themselves? Any way you can get them to be more specific about exactly what is worse?

     
    Old 08-12-2012, 07:24 PM   #12
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    Re: Ventral cord deformity and narrowing... among other things

    Thanks again for your quick response. You got exactly out of it what I did, a great big "huh?" While she mentions "spondylosis," which I can easily definite, the other explanations see innocuous and subjective at best, completely confusing, up for confused interpretation, and plain incorrect without any elaboration at worst. The use of "some" and "appears to be..." junk like that drives me crazy, particularly using words in place of typical terminology, like "narrowing" instead of stenosis, and "some" instead of explaining what some is. I can't define such general means of stating things. Maybe that's what my doctor meant when he says she made it sound like it wasn't a big deal when you read it. I've had other MRIs of the same area that used "severe" on other places a while back and this recent MRI report indicates that things have gotten worse since the last one (no cord compression or narrowing mentioned before, and no kyphosis mentioned either). And the fact that the kyphosis finding wasn't even mentioned in the impression is weird to me too. It's like saying someone has scoliosis but makes no mention of it on the summary of findings. Huh? From what I've read, left untreated and progressing, it could lead to deformity of the cervical spine and affect my physical appearance as well, as well as additional pain and risks to the cord. Good grief! Well, I guess we'll find out more during the neuro visit in sept. :-/ Kyphosis means that the cervical spine is straightening and losing its natural C curve. Eventually it makes your head off balance,
    Causing it to stick out forward like a duck and appear droopy, and in severe cases look like a hunch back!!! What the frig??

    Btw, in my last MRI the report says "severe bulging disc anterior of the C-6..." and you can actually see the disc bulging so far that it's almost touching my esophagus!! No mention of "severe" anywhere in this MRI report.

    The developmental venous anomaly in the brain means I have a bunch of draining veins that look all tangled up. It was never mentioned in my prior brain MRI, although that one was without contrast. This is usually an insignificant finding unless a cavernous angioma is also present, which would indicate a pending aneurysm. But mine wasn't. It also says that it's insignificant unless it's causing symptoms. Could my flare ups be causing the DVA (as they refer to this) to press upon my maxillary trigeminal nerve affecting my facial issues at the same time that the flare up is affecting my arm? I have no idea. Just my amateur speculation. I guess I'll know when I see the neuro in a month. I'll keep you posted.

    Thanks again for taking a stab at it :-\

    Last edited by gav_73; 08-12-2012 at 07:40 PM.

     
    Old 08-12-2012, 08:09 PM   #13
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    Re: Ventral cord deformity and narrowing... among other things

    Well, the good thing is that the doc(s) you see will most likely look at the images, and maybe even completely ignore the report.

    My suggestion that you get another radiologist to look at the images was at least half for your understanding, rather than that of the docs.

     
    Old 08-13-2012, 09:15 AM   #14
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    Re: Ventral cord deformity and narrowing... among other things

    Thanks Webdozer. What's weird is that I called the ortho and spoke with his PA about my MRI report and asked specifically if I had stenosis and what the main observations and issues were with my MRI. He said "You have an appt with a neurologist, right?" When I said yes he said that I should first see the neuro and see what he says, then we can discuss further. What the heck? Can't they just tell me their thoughts and what the MRI says before I go? Maybe they're confused too. Grrrr

     
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