It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Spinal Cord Disorders Message Board

  • Help with deciphering MRI results

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-12-2012, 07:58 AM   #1
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Question Help with deciphering MRI results

    Hi all! I am new to the group and just recently had an mri done on my neck. About 4 months ago I started experiencing pain under my left shoulder blade. The pain is pretty much relentless. I had an x-ray done in the middle of June and my doc sent me to PT. After about 4 weeks of PT, my problem became worse. The pain spread down my arm and my hand has partial numbness along with lots of tingling and "electrical shock" which is quite strong depending on what I am doing. From the MRI, I can understand that I have a herniated discs at the C4-C5 and C6-C7 along with bone spurs and stenosis. I will be seeing a neurosurgeon next week. I would like to avoid surgery at all costs, but I know I know that I need help. Here's a synopsis of the MRI report:


    C4-C5 - central disc herniation and posterior osteophyte. Herniation measures 1.6 cm transverse x 0.7 cm anterior to posterior. Moderate canal stenosis effacing the ventral aspect of the spinal cord. Mild right sided and mild to moderate left sided neural forminal stenosis.

    C5-C6 - posterior disc osteophyte complex and mild canal stenosis. There is moderate bilateral neural foraminal stenosis secondary to posterior osteophyte.

    C6-C7 - broad posterior disc herniation measuring 2.2 CM transverse X 0.6 cm anterior to posterior; this is more prominent on left than right. This causes moderate canal stenosis effacing the ventral aspect of the spinal cord. This causes moderate to severe left-sided neural foraminal stenosis. There is minimal right sided neural forminal stenosis.

    There is very slight increased T2 signal in the spinal cord at the C4-C5 level, likely secondary to chronic impression of the spinal cord from the above mentioned disc herniation.

    The group's input on this mri interpretation and what kind of treatment might be used would be greatly appreciated.

    Thanks!

     
    Sponsors Lightbulb
       
    Old 08-12-2012, 08:11 AM   #2
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    I hope all those "cm" measurements are actually "mm" !

     
    Old 08-12-2012, 09:39 AM   #3
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    Well, I double checked the results letter I received and all of the measurements do say CM.

    Beckel

     
    Old 08-12-2012, 10:54 AM   #4
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    Pretty big, then...

    Just some terms:

    Minimal/Mild/Moderate/Severe is standard terminology to describe how serious an anomaly is. Your radiologist clearly follows this.

    Disk herniation means that the tough outer shell of the disk is torn and the soft inner material is spilling out. A herniation can occur with or without the disk itself bulging out of place.

    Posterior disk osteophyte complex - over time, wear and tear on the spine causes bone spurs (osteophytes) to grow from the areas of the vertebrae where they interface with the disks.

    Stenosis = narrowing

    Effacing Ventral Aspect - whatever is pushing backward into the spinal canal (herniated disk material and/or osteophytes) has effaced (pushed away) the spinal fluid inside the spinal canal that cushions the spinal cord.

    Neural foraminal stenosis - the spinal nerves leave the cord and pass through the foramina, which are holes in the front/side of the spine. Going through the foramina, they can be pinched by osteophytes or disks.

    At C4-5, the radiologist is saying that the disk herniation is causing "moderate" canal narrowing. That's only one step below "severe". He does NOT say that the cord itself is affected, only that its spinal fluid cushion has been pushed away. HOWEVER, he later notes increased T2 signal at that level, which MAY indicate cord damage, and he hypothecizes that it's due to the herniation.

    At C5-6, you don't seem to have a herniation, but you do have a d-o complex. I'm wondering if it's a bit of an either/or situation, that is, that the disk NOT herniating meant that pressure on the vertebrae was not relieved, and they responding by creating bone spurs. Just an uneducated speculation on my part, though.

    At C6-7, the disk herniation may be having a similar effect on the canal, but it's lopsided to the left, and appears to be seriously narrowing the left foraminal opening. If the C7 nerve is being pinched here, it could have symptoms running down the back of the arm and into the middle fingers.

    What about the C7-T1 level? That should be included on a cervical MRI.

    As for the foraminal narrowing at C4-5 and C5-6, that could be affecting your arm, your deltoid muscles in your shoulders, and down to your thumbs.

    I have no idea of what's causing the pain under your left shoulder blade, unless it's "referred" from your neck.

    As for treatment, I see several problems that would work against conservative alternatives:

    1) The disks are not just bulging, they are herniated. I don't THINK there's any way of getting the out-of-place material back where it belongs

    2) The herniations are large and, if they are not already affecting the spinal cord, they are on the edge of doing so.

    3) The increased T2 is worrisome in that it may be a sign of cord damage.

    I'm afraid that the neurosurgeon is going to recommend ACDF (removing the disks and fusing the vertebrae) at all three problem levels.

    Of course, it's the surgeon's opinion that counts, not mine. I do, however, STRONGLY urge you to get THREE opinions, especially since you so much want to avoid surgery. If you get only one opinion, then have surgery, any post-op problems will have you endlessly second-guessing yourself.

    Last edited by WebDozer; 08-12-2012 at 11:13 AM.

     
    The Following User Says Thank You to WebDozer For This Useful Post:
    Beckel1952 (08-12-2012)
    Old 08-12-2012, 04:53 PM   #5
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    Thank you so much for taking the time to answer my questions. Yes, I am reluctant to have surgery, but the truth of the matter is that I don't know how much longer I can take this pain. It has been ongoing since April and the pain medication I take has very little effect on it. Due to a gastrointestinal disease, I am prohibited from taking NSAID's. I take Lortabs for severe arthritis and I am at the maximum daily dosage on them. The first two neurosurgeons I wanted to see were booked up for months. The doctor I am seeing Tuesday is in practice with one of them. I did have surgery many years ago for a herniated disc in the lumbar region. The surgery was a success and did relieve that horrendous pain. I will definitely get another opinion, just hate to wait so long for another appointment. Once again, I really appreciate your help.

    Beckel

     
    Old 08-12-2012, 04:56 PM   #6
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    Thank you so much for taking the time to answer my questions. Yes, I am reluctant to have surgery, but the truth of the matter is that I don't know how much longer I can take this pain. It has been ongoing since April and the pain medication I take has very little effect on it. Due to a gastrointestinal disease, I am prohibited from taking NSAID's. I take Lortabs for severe arthritis and I am at the maximum daily dosage on them. The first two neurosurgeons I wanted to see were booked up for months. The doctor I am seeing Tuesday is in practice with one of them. I did have surgery many years ago for a herniated disc in the lumbar region. The surgery was a success and did relieve that horrendous pain. I will definitely get another opinion, just hate to wait so long for another appointment. Once again, I really appreciate your help.

    Beckel

     
    Old 08-12-2012, 06:37 PM   #7
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    Getting appointments can be a *****, sometimes. A friend of mine just got the earliest appointment she could with a neurologist, October 29... and she's in LA!

    Still, you need to get multiple opinions. You may very well need a three-level ACDF, but you'll want to find out about all your alternatives.

     
    Old 08-15-2012, 12:10 PM   #8
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    Quote:
    Originally Posted by WebDozer View Post
    Getting appointments can be a *****, sometimes. A friend of mine just got the earliest appointment she could with a neurologist, October 29... and she's in LA!

    Still, you need to get multiple opinions. You may very well need a three-level ACDF, but you'll want to find out about all your alternatives.
    Well, WebDozer, you were right on the money, honey, ha ha! Saw the neurosurgeon yesterday (whom, I, by the way liked immensely - he is affiliated with our local med school). He basically told me there was no conservative treatment that would help me. He recommended a two level ACDF. The first level would be the C4-5 and the second C6-7. He recommended leaving the C-5-6 alone because it's not actually herniated and would benefit from the stabilization of the other two levels. I just about freaked out when I saw the effects of the compression of the C-6-7 on the mri. It looks like it is half way into my spinal cord! God bless the man! I begged my primary care doc to give me some pain medicine that would work, but he refused. The neuro doc prescribed percocet, steroids and medication to protect my stomach from the pain meds. But I already take Prilosec twice a day, so I didn't need that. Last night I took the pain medication before I went to bed and was actually able to sleep 4 or 5 hours peacefully! I have known from the beginning where my journey was gonna end. I knew that therapy, shots, etc. were not going to help me. I also know that most surgeons will try every last conservative treatment before recommending surgery. I know that you recommend a second opinion, and I may be wrong, but I really liked this doctor. He spent almost two hours with me and my daughter and I felt very comfortable with him. And I'm just about at the end of my rope with the pain. I'm pretty sure I'm going to set a date for the surgery. And if I do, I will really need the help of the board to give me some advice, both pre-op and post-op. Once again, thanks so much for your help. It's so reassuring to know that there are people out there who have gone through or are going through the same thing.

    Beckel

     
    Old 08-15-2012, 12:36 PM   #9
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    I was hoping you would come upon some less invasive way of dealing with herniated disks, but I guess that's not to happen. I'm surprised the compression at C6-7 looks so bad, as the radiologist only said the CANAL is narrowed, not the CORD. That is, the spinal fluid surrounding the cord has been pushed away (effaced). Are you sure you weren't seeing the indentation in the canal? The cord is dark and the fluid is light, on an MRI.

    I'm also surprised that he wants to skip the middle level. You may see a lot about "adjacent disk syndrome" on this or other boards. That's where - supposedly - fusing one disk puts increased pressure on the adjacent disks, increasing the likelihood of their going bad, as well. I've never been a big believer in ADS, as I think it's more likely a correlative than a causative effect. I wonder if the level BETWEEN two fused levels might somehow be protected?

    As for range-of-motion loss, I suppose the surgeon said something? I'm guessing maybe 40%?

     
    Old 08-15-2012, 03:57 PM   #10
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    I am no expert at viewing mri's so it was probably the indentation in the canal that I was seeing...I was just surprised at how large the herniation was. I too was thinking that with leaving the middle level intact, that the fused level above and below would some how protect it, similar to maybe reinforcing it. I didn't ask about the loss of motion range. It totally slipped my mind. I would need to discuss this with him if I decide on the surgery. Is it possible to really lose 40% of your range of motion with this surgery? You mention trying to find a less invasive way of dealing with the situation, I really don't know what else could be done, what alternatives there are. I guess I'm just confused, overwhelmed, in lots of pain and I am scared. I've read so many conflicting stories about the surgery, that I am now having serious doubts about even considering it. If I were able to find a way to relieve the extreme pain, the numbness and the electrical shocks with epidural or something, would the pressure of the large herniated discs eventually lead to more serious problems? The only thing I know for sure is that I cannot live the rest of my life with this pain.The numbness, the tingling, the electrical shock, I could live with. But not the pain. :-(

     
    Old 08-15-2012, 04:05 PM   #11
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    I really, really think you need more opinions. They may be different than the one you've gotten, although I have no expectations one way or the other. You just need more clarity. If the extra opinions confuse the issue, they will only do so by providing you with more options. However, I wouldn't dawdle. If that T2 signal is indicative of cord damage, that's not something you want to just live with.

    The 40% loss of range was just a guess on my part. Different levels contribute different percentages to the whole. I would just say that fear of losing some range should not - by itself - deter you from surgery, although it may be a consideration in WHICH surgery, if you have options.

    Last edited by WebDozer; 08-15-2012 at 04:07 PM.

     
    Old 08-15-2012, 05:22 PM   #12
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    I am not afraid of losing some range. At this time, I can barely bend my head back. Let's just say, if I try to look at the stars, I see "stars" ha ha! Losing some range would not deter me from surgery. You mention more than one type of surgery for this condition. Would it be possible for you to list some of the alternative surgeries available? I realize I am taking up a lot of your time and I really appreciate your help with this.

    Last edited by Beckel1952; 08-15-2012 at 05:24 PM. Reason: rephrasing

     
    Old 08-15-2012, 05:35 PM   #13
    WebDozer
    Inactive
    (female)
     
    Join Date: May 2011
    Location: So Cal
    Posts: 1,379
    WebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB UserWebDozer HB User
    Re: Help with deciphering MRI results

    I'm really aware of only three basic kinds of surgeries, although I keep seeing ads for new, "minimally invasive" stuff.

    - ACDF's, which has been recommended for you

    - foraminotomies - minimally invasive procedure going in from behind and cutting away bone or tissue that's crimping the foraminal openings - this was designed for foramina only, not disks, but the newer versions may work on disks or herniated disk material also

    - decompression - this could be a laminectomy, where the back part of the spine (the lamina and spinous process) is removed to increase the room in the canal... or it could be a laminoplasty, where the lamina are cut on one side and swung open

    I've had an ACDF, a foraminotomy and a laminoplasty. I did not bring up the latter two only because my limited knowledge leads me to believe that they would not be appropriate in your case.

    I'm sure, though, that the options improve every year. That does not mean, though, that any given surgeon, no matter how skillful he may be, is up to date on all of them. Hence, the need for two more opinions. You've got nothing to lose but a few $hundred...

     
    Old 08-15-2012, 05:53 PM   #14
    Beckel1952
    Junior Member
    (female)
     
    Join Date: Aug 2012
    Posts: 12
    Beckel1952 HB User
    Re: Help with deciphering MRI results

    Well, to me your knowledge is not limited at all. Yes, I've read about the "minimally invasive" surgeries, the artificial disc surgeries, etc. I have decent health insurance, so choosing to have a second or third opinion wouldn't be a problem. The only problem is where I live. It's a relatively small town with two groups of neurosurgeons. I've already seen one in one group and I couldn't get in with the other group until October. I may be able to check out some farther away from me. Again, thank you for the information. I will make some calls tomorrow and see if I might possibly get in with someone else fairly quickly.

     
    Closed Thread




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 05:36 PM.





    2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!