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    Old 06-14-2013, 08:27 AM   #1
    mtillges
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    Question need help understanding second MRI Results

    I was recently rejected for health insurence and I'm try to better understand in common terms what mt latest MRI result mean:
    Is there anyone out there on this board how is qualified to interpit my MRI results?

     
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    Old 06-14-2013, 08:31 AM   #2
    mtillges
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    Re: need help understanding second MRI Results

    here are my MRI results

    EXAM: MRI OF THE CERVICAL SPINE WITHOUT CONTRAST

    CLINICAL INFORMATION: Cervical disc degeneration. Dystonia. Cervicogenic headache. Occipital neuralgia. Migraine headaches. There are no comparison cervical spine imaging studies available for review.

    TECHNICAL INFORMATION: Sagittal long TR/long TE, sagittal short TR/short TE, sagittal MPGR, axial MPGR, and axial long TR/long TE noncontrast images.

    INTERPRETATION: There is preservation of normal cervical lordotic curvature. Vertebral body heights are normal. There is marked spinal canal stenosis developmentally with the canal AP diameter distant from discs typically 10 mm (sagittal image 7). There is additional acquired stenosis at disc levels due to minor bulging (see below). In addition, there is generalized foraminal stenosis which appears developmental, along with superimposed acquired stenosis from uncovertebral overgrowth causing moderate foraminal stenosis at multiple levels (see below). Marrow signal is normal.

    Cerebellar tonsils are normally located. Spinal cord signal is normal, even where the cord is mildly deformed in the mid cervical segment (axial images 19, 23, 28).

    There is mild right C4-C5 and C7-T1 facet arthrosis, remaining facets and craniocervical articulations appearing normal.

    Disc dehydration (long TR) is moderate at all levels. Disc height loss is mild above T1.

    At the upper thoracic spine imaged there are shallow paracentral bulges at T1-T2 slightly indenting the sac (axial images 4).

    At C7-T1, there is a shallow posterior disc bulge eccentric to the right slightly indenting the sac (axial images 9) resulting in moderate right foraminal stenosis.

    At C6-C7, there is a shallow posterior disc bulge eccentric to the left with a small central protrusion, disc material 2-3 mm AP (axial images 15) resulting in moderate deformity of the sac and minimal flattening of anterior cord margin along with moderate left greater than right bilateral foraminal stenosis.

    At C5-C6, there is a small 2-3 mm central protrusion (axial images 19) moderately indenting the sac and mild deforming the anterior cord margin; there is also uncovertebral overgrowth with moderate left foraminal stenosis.

    At C4-C5, there is a shallow posterior disc bulge moderately indenting the sac and mild deforming the anterior cord margin (series 6, image 23) and there is moderate left foraminal stenosis.

    At C3-C4, there is a shallow posterior disc bulge and superimposed small central protrusion, 3 mm AP, moderately indenting the sac and mild deforming the anterior cord margin, blunting with uncovertebral osteophyte on the left resulting in moderate/marked left and moderate right foraminal stenosis (axial images 29).

    At C2-C3, there is a shallow posterior disc bulge with uncovertebral overgrowth causing moderate left foraminal stenosis.

    Cervical soft tissues imaged appear normal; there are normal major arterial flow voids.

    CONCLUSION: Developmental pronounced spinal canal stenosis with lesser developmental foraminal stenosis, along with superimposed acquired stenosis from bulging discs and uncovertebral overgrowth:
    1. There are moderate indentations on the sac and mild deformity of the spinal cord at multiple levels, although the spinal cord signal is normal with no evidence of myelomalacia.
    2. Foraminal stenosis is generally mild but uncovertebral overgrowth has resulted in moderate/marked left C3-C4 and moderate right C3-C4, left C4-C5, C5-C6, and C7-T1, and bilateral C6-C7 foraminal

     
    Old 06-14-2013, 05:15 PM   #3
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    Re: need help understanding second MRI Results

    You have "developmental spinal stenosis", which means that your heredity has bestowed you with a narrower-than-normal spinal canal. I have the same problem. Your canal is about 10mm (that is, before anything intrudes), and normal might be 15+. This doesn't matter until you start to develop intrusions into the canal, usually from bulging disks or bone overgrowths. When these problems occur, you have less margin for error in the canal. That is, you have less space filled with cerebrospinal fluid cushioning the spinal cord. Relatively minor bulges and overgrowths can reach - and impact - the cord. These bulges and overgrowths are what he's referring to as "superimposed" stenosis.

    As for those intrusions, the standard terminology in describing their size is minimal-mild-moderate-severe. Normally, only "severe" would be taken seriously. However, due to your hereditarily narrow canal, a "moderate"-sized intrusion might be the same as a "severe" intrusion for someone else.

    At several levels you have "moderate" intrusions pushing on your thecal sac, which is the membrane surrounding your spinal canal and holding in the cerebrospinal fluid. These are NOT problems until they reach the cord, and due to your developmental stenosis, in your case they don't have to go as far to reach the cord. Still, even where they have reached it, their impressions on it are only mild, and are not causing abnormalities that the radiologist can detect. Signal changes and myelomalacia are both things you really don't want to have. That said, just because the radiologist can't detect abnormalities doesn't mean they aren't there.

    As for the foraminal stenosis... your foramina are the holes in the front/side of the spinal cage through which pass your spinal nerves after leaving the cord. Your developmental stenosis also means that your foramina start out narrower than the average person's. Disk bulges, or bone overgrowth from the top/bottom margins of the vertebrae (uncovertebral "joints") may push back into the foramina. If they impact a spinal nerve, that's called "radiculopathy" ("trouble with the root"). This can cause a range of symptoms anywhere DOWNSTREAM on that nerve. For example, the C6 nerve (leaving from the C5-6 level) goes down the back of your arm (triceps) and into your thumb.

    Your worst foraminal level seems to be the left side at C3-4, thus affecting the C4 nerve. The C4 pretty much just goes to your shoulders and collarbone area.

    Cervical disk degeneration is pretty much the rule for people of a certain age.

    I am not qualified to comment on the headaches, neuralgia or dystonia (which sounds like a real *****). I don't understand the basis on which he thinks the headaches are cervicogenic. Maybe you have a problem ABOVE C3-4, or maybe he thinks the pain in your head is originating in your neck?

    Anyway, at least based on the radiologist's report - and my own amateur's understanding - there is nothing that really jumps out as problematic, except maybe that left C3-4 stenosis.

    Because of the developmental stenosis of your canal, you may at some point become a candidate for decompressive surgery (i.e. laminoplasty). You may, right now, benefit from a relatively minor surgery (foraminotomy) to clear up your narrowed foramina.

    I would say that your got an unusually good radiologist's report. Now you need to get multiple opinions from advanced specialists such as neurologists and spinal surgeons.

    Last edited by WebDozer; 06-14-2013 at 05:21 PM.

     
    Old 06-14-2013, 06:33 PM   #4
    mtillges
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    Re: need help understanding second MRI Results

    Hi WebDozer
    Thanks you so much for taking the time to explain my MRI in a way I can understand it.

    I think the biggest surprise to me was that this is the second MRI I've had in 12 months and the first MRI results did not state anything about me having "developmental spinal stenosis". This new MRI was reviewed by a specialist in Diagnostic Radiology, and Vascular & Interventional Radiology.
    FYI, I did end up having a Cervical (Neck) Epidurography/Epidural immediately following this second MRI which did provide relief for the daily headaches, but the on & off numbness and sleep interruption has not improved.

    One quick question. Can you clarify your second to the last statement.
    "I would say that your got an unusually good radiologist's report." - Are you saying a good radiologist or good MRI results considering all the issues with my spine?

     
    Old 06-14-2013, 07:01 PM   #5
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    Re: need help understanding second MRI Results

    I meant that the radiologist did an unusually good job. For one thing, he identified developmental stenosis. Not only that, he gave you a measurement (10mm). Aside from my own MRI, I think that may be the first time I've seen a radiologist do that. I have, however, seen many reports where what are described as relatively small intrusions into the canal are said to be impacting the spinal cord. A small intrusion can't reach the cord unless the canal is undersized to start out with. So I've had to infer developmental stenosis, when the radiologist SHOULD have been explicit that it was there.

    Last edited by WebDozer; 06-14-2013 at 07:03 PM.

     
    Old 06-14-2013, 07:28 PM   #6
    mtillges
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    Re: need help understanding second MRI Results

    Thanks so much for getting back to me. Now I hope I can find a neurologist as good as the radiologist. Is it common for someone like me to ask the radiologist to recommend a good neurologist?

     
    Old 06-15-2013, 10:23 AM   #7
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    Re: need help understanding second MRI Results

    Sorry... can't help with that. I've heard that neurologists can be hard to get to see...

     
    Old 06-15-2013, 10:50 AM   #8
    mtillges
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    Re: need help understanding second MRI Results

    That is what I've seen.

     
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