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  • Osteodiscal Bars?? MRI translation

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    Old 01-09-2014, 04:10 PM   #1
    James620
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    Osteodiscal Bars?? MRI translation

    I wonder if someone can help me with a recent MRI report understanding.

    My history is I had a significant prolapse at C4/5 and a partial at C3/4. I had a anterior cervical discectomy and replacement as it cervical myelopathy. My symptoms at the time were numbness in both hands and arms, loss of sensation and sever loss of co-ordination in my hands, pain in the neck arms and shoulders and tingling in my feet.

    In July 2012 I had the surgery and made a pretty much 100% full recovery.

    In Oct 2013 while lifting something at work I felt a pinch in my neck, and hoped it was a pulled muscle. Since then I have had numerous trips to the doctors until finally an MRI was arranged after symptoms increased to nerve pain in the left arm, numbness in my left thumb, tingling in left 2 first fingers, shoulder pain, neck pain and shoulder blade pain.

    I have finally recovered the MRI report today and would appreciate any ideas as to what basically the next move will be and if possible what it means!!!

    I can't get back to my neurosurgeon for another 4 weeks as they are too busy.......

    The reports states

    **************************************** ************************

    There has been a previous disc replacement at C4-5, with metal plate in both end plates. This creates a significant artefact. It is not possible to comment on the cord at this level.

    There is a reversal of the normal cervical lordosis centered on C4-5 with spondylitis change above and below this level.

    There is a prominent osteodiscal bar at C3-4 that abuts the cord but there is no evidence of myelopathic change.

    There is a further osteodiscal bar a C6-7. Again this indents the cord but without convincing evidence of myelopathic change. This level however ois difficult to assess due to the metal artefact.

    **************************************** ************************

    Last edited by James620; 01-09-2014 at 04:12 PM. Reason: Update

     
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    Old 01-10-2014, 08:02 AM   #2
    WebDozer
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    Re: Osteodiscal Bars?? MRI translation

    A pet peeve of mine (a pet the size of a musk ox, that is) is lousy radiologist reports, and you seem to have gotten one.

    In any good report, there are ALWAYS descriptions of two aspects of the spine. First, the condition of the spinal canal, whatever may be intruding into it, and the effect of these intrusions on the cord. You sort of got this, although the radiologist bailed as far as describing anything around your prior surgery. (perhaps this is the fault of the MRI, though, as it's difficult to image areas that have hardware in them)

    Second - and what your radiologist couldn't be bothered with - is an evaluation of the foramina, that is, the openings in the front/side of the spinal structure through which pass the nerve roots after leaving the cord. Even a half-way decent report should always have such an evaluation, even it it's only to say the foramina are "patent" (open) at every level. To evaluate the foramina, one must look at the horizontal slices of the MRI, which can be difficult to read sometimes. I wonder if you just got a radiologist who couldn't handle this....

    Also, he says nothing about C5-6, which is the level that would be of GREATEST concern after removal of the C4-5. I would note that he said C6-7 "AGAIN indents the cord". As he said that C3-4 only ABUTS the cord, might he have said that C5-6 "indents" the cord, and that got lost in one of the transcriptions?

    Oh well, enough complaining about the radiologist. Your NS should read the images for himself, and he can fill in what the radiologist skipped over.

    OK, to your symptoms.... can I assume that your "neck pain and shoulder pain" are also left-side? If so, you would seem to have something affecting your left C6 and left C7 nerves (coming from the C5-6 and C6-7 levels). Look up dermatome + C6 to get a diagram of what areas are innervated by those nerves. The big question though, is if the problem is due to an impingement on the cord itself, or an impingement on the C6 and C7 nerves after they leave the cord and are passing through the foramina. While the left-sidedness of your symptoms would seem to indicate foraminal (nerve root) impingement, it's quite possible for impingement on the cord to produce one-sided symptoms, as well. Cord impingement can affect pretty much anything below the problem level, so if you're having trouble in your legs or feet, that would be telling.

    As for what to do next... the NS should review the MRI images himself. I have had two NS's tell me they pretty much ignore what the radiologists say. This makes sense, as the radiologist is a generalist, and the NS's absolutely MUST understand the MRI's better than anyone else.

    Still, I think it would be very useful to you to have the best understanding you can get before seeing the NS, and this, in your case, means getting a decent radiologist's review of your MRI. The first thing I'd want to know about is C5-6. Then, I'd want to know his review of the foramina - on both sides and at every level. Finally, I'd like to know why he said there was little or no evidence of "myelopathic change". Is he referring to signal intensity? Myelomalacia?

    I realize it's hard going back to a doc and asking him to do his job better, but you asked me what your next step should be, and this is what I'd suggest.

    in edit... if you want to know what "osteodiscal bars" are, I'm sure they're what's usually known as "disc-osteophyte complexes". What happens is that disk degeneration puts added stress on the vertebrae where they interface with the disks. Over years, the vertebrae lay on extra bone to compensate, this bone being called "spurs" or "osteophytes". These bony protrusions from the vertebrae - perhaps with a bulging disk sandwiched in between - push back into the spinal canal and/or the foramina. Depending on the size of the protrusions - and also depending on how spacious your canal was to start out with - they might push into the spinal cord itself, or impinge on the nerve roots passing through the foramina.

    Last edited by WebDozer; 01-10-2014 at 08:14 AM.

     
    Old 01-10-2014, 10:04 AM   #3
    James620
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    Re: Osteodiscal Bars?? MRI translation

    WebDozer, thank you so much for taking the time to reply, that really helps I may get a second opinion from an private MRI radiologer in that case. I am getting shooting pains in my legs and toes and a heavy feeling in my legs. All the symptoms are left side as well.

    Again thank you you've been more helpful than any doctors I've seen, one orthopedic doctor said 'there's nothing on your scan you're fine...!!'

     
    Old 01-10-2014, 10:16 AM   #4
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    Re: Osteodiscal Bars?? MRI translation

    Did the orthopod look at the images or just read the report?

    As for the leg trouble, I guess it's clear to you that this can be caused by cord impingement anywhere "upstream"? So, in the case of your legs, the problem could be either cervical or lumbar?

    My first operation was to remove my herniated C3-4 disk. I had symptoms in my shoulder, hand, and leg, all right-sided. Since the C4 nerve does not innervate the arm, my problem could ONLY have been cord impingement, and that cord impingement could also have been causing my leg symptoms (which it was).

    I do think you need a better MRI reading, although you may need a better MRI, as well, which is somewhat costlier. I have to think, though, that the complete lack of commentary on your foramina is strong evidence that the radiologist himself is the problem. You can wait on the NS to read the images, or you can gamble a little money that a better radiologist will give you enough additional information to make it worthwhile.

    When you had that pinch in your neck, did all of the symptoms come on immediately?

     
    Old 01-11-2014, 05:31 PM   #5
    James620
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    Re: Osteodiscal Bars?? MRI translation

    The orthopedic doctor just looked at the images I believe, but it's clear on the images it's not right really as the spinal cord looks twisted...! (I don't think I can upload the best picture)

    I've managed to get a ct scan next week so hopefully that will speed things up

    No the symptoms have come on progressively over a period of 4-8 weeks they get worse, better and then worse again

     
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