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  • MRI results C4 & C6/7 thecal compression

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    Old 06-14-2014, 11:39 PM   #1
    Alizarin
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    MRI results C4 & C6/7 thecal compression

    Hi

    Found this site and read through people's very similar conditions. Really Informative but I have a few specific questions of my own so new thread. I posted under. General Health by accident, this belongs here.

    MRI Results Axial imaging done between C3-T2.

    C4-5: Broad-based disc osteophyte bar compressing the theca and causing moderate severe bilateral C5 exit foraminal stenosis.
    C5-6: Broad-based disc osteophyte bar with right para midline predominance causing severe C6 exit foraminal stenosis and the exiting right C6 nerve root is likely to be impinged. Mild to moderate left C6 exit foraminal stenosis. Bilateral facet joint degenerative changes noted.
    C6-7: Broad-based disc osteophyte bar compressing the theca and indents the ventral surface of the cord. Severe left C7 exit foraminal stenosis and exiting left C7 nerve root is impinged. Mild right C7 exit for animal stenosis. Bilateral facet joint degenerative changes noted.
    Rest of axially imaged spine unremarkable

    If someone could explain those parts in italic I'd be most grateful.

    From what I have seen clearly on my MRI & read here as a guide, I have 3 bony spurs pinching down on the spinal cord by C4 and C6/C7 vertebrae. This shows on the scan a bottle-neck effect on the spinal fluid, there is hardly any between these vertebrae and excess bulges either end.

    This started in March. Put on eventual Pregabalin and Butrans patches for pain relief. Referred to physio. I had a brief 2 week window in April where things lessened off but the physio next exercises started in May antagonised everything and it came back 10-fold. Now pain relief ineffective.

    If things are actually impinging on the cord, I don't believe physio is particularly advisable? Any thoughts? Neck brace seems better to me but what do I know? GP says they don't advise them anymore.

    Also, I have been referred to a neurospinal neck man but with a 6 week waiting list. This seems too long as some people here have commented irreparable damage may result the longer the cord is being impacted? What severe long-term worst case scenario could be? Paralysis? Permanent pain?

    It certainly feels too long from my 'coping with the pain' is concerned. I feel like tearing my arm off and cannot keep still for more than a few minutes, constant agony. No position offers any respite, laying down to sleep is impossible. I manage an hour at most and then the pain is worse when I wake. The pins & needles extend all the way to my thumb, index and middle finger. The index finger is completely numb most of the time, which I believe indicates C6?

    This post is getting to be a novella so I will stop here and look forward to any translation, advice, suggestions etc. Thanks for reading.

     
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    Old 06-15-2014, 03:37 PM   #2
    ChuckStr
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    Re: MRI results C4 & C6/7 thecal compression

    I'm not a Dr, just a guy with chronic spine issues who has lol earned a lot of the lingo to better understand what is happening, and has seen numerous spine drs for advice.

    Broad based disk osteophyte complex - The vertebrae in the neck have a vertebral body which is a cylindrical piece of bone. Adjacent vertebral bodies have disks between them with a gel like substance to cushion and allow spine movement. Off the back of the body, each vertebra has bony ridges to the left and right as well as one in the back (called the spinous process, this is what you feel when you feel the back of your neck). These ridges make a hole for your spinal cord (spinal canal). The left and right ridges also connect with the adjacent vertebrae to make holes (foramen) for the nerve roots coming off the spinal cord. These ridges can develop bone spurs (osteophytes) through arthritic degeneration. When bone spurs from multiple leves come together the make an osteophyte complex. Broad based - in this case means indicates that they are thicker closer to the ridges.

    Bilateral - in this case means affecting both of the ipening for the nerves (right and left)

    C5/c6- means you have an osteophyte complex to the right of center orginatng from the vertebral body pushing predominantly into the right foramen. Likely pushing on the right nerve which could cause significant pain and possibly numbness in your right arm and possibly into your hand. The facet joints are the back parts of the ridges hat come together to make the foramen. The radiologist doesn't comment on the severity of these changes so they are unlikely to he significant.

    C6/c7 - likely compression of left nerve root. Would likely cause left hand and forearm pain, numbness etc.

    From the radiologist's comments you do have some relatively minor pressing into the central canal. But from your description of symptms I'm not sure that is the cause. It's more likely the compression of the nerve roots. Pressing into the central canal can have serious consequences but yours seems pretty mild from the language in the MRI. This will be something to discuss with your spine Dr. The consensus of my Drs is that if there is not definite compression on the cord with myelopathic symptoms (gait disturbances, weakness, incoordination, bladder symptoms reflex changes), conservative approaches are warranted.

    6 weeks is a long time to wait in that much pain. Nerve root compression can result in permanent nerve damage whic could mean permanent pain, weakness and atrophy of affected muscles. That said, most nerve root compression syndrmes resolve with conservative measures (pt, cervical traction, steroid injections etc). Yours sounds very tight however. I would see if you can get into a spine specialist earlier, and if anyone suggests surgery that you get multiple opinions.

     
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    Old 06-16-2014, 09:09 AM   #3
    Alizarin
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    Re: MRI results C4 & C6/7 thecal compression

    Thanks Chuck,
    I hoped I would get your attention as I read your answers to others and found them very informative but wanted more information about my particular problem.

    I understood most of the MRI report but needed the gaps filled in, which you have done.

    It's the C6 that is responsible for all my pain, which radiates down the arm as a burning, electric nerve pain as well as numbness of the 3 fingers, index to ring but mostly the index. I also get extreme pins and needles down the whole arm and even across my chest, which is frightening. The right side gets an a he in the neck/shoulder muscle but atm goes away on movement. The GP said that all this is most likely responsible for my peripheral neuropathy, which I have had and been diagnosed with 2 years ago. The osteoarthritis was obviously building up during that period.

    It's an awful condition and I feel for anyone with spinal and any nerve pain.

    The meds I am on don't touch it, Pregabalin and morphine. It is agony and I can't stay in one position for more than a few minutes. The thought of a 6 week wait just for a consultation is unbearable, I will try and harass my doctor for a quicker appointment but don't have much hope. Things move more quickly in the States.

    Thanks for taking the time to read and reply.
    All the best, Alizarin. ��

     
    Old 06-16-2014, 01:07 PM   #4
    ChuckStr
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    Re: MRI results C4 & C6/7 thecal compression

    Yes, I've gotten the chest involvement over the years. It's probably responsible for several trips to the ER with chest pain now that I know what it is. This current round I had pain of the intensity you're talking about but luckily it went away after a few weeks of easy PT/rest/steroids. I'm still left with a significant strength reduction in the c6 enervated muscles of my left arm though. Slowly getting better (I think).

    I definitely feel for you. They don't give morphine very easily in the states but I've had it when I had my last cervical MRI at the hospital and if that isn't working, I'd do whatever I could to see someone ASAP. Also, maybe see if you can get a script for cervical traction. It is not always recommended with cord compression (although 2 of my surgeons and my neuro all suggested it for me) as my compression is very minimal. Something to discuss with your dr. Maybe if you do it under PT care to start as I have, that would be better. There are many studies attesting to pain relief through traction (although my pain was already mostly gone when I started it).

    I hope you find some relief before 6 weeks. Good Luck.

     
    Old 06-22-2014, 03:21 PM   #5
    Alizarin
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    Re: MRI results C4 & C6/7 thecal compression

    Hi Chuck

    Thanks for sending another message. Just to clarify, I am not in the US but over the pond in the UK on our hard pushed NHS service. Got our wires crossed somewhere.

    From your comment ' From the radiologist's comments you do have some relatively minor pressing into the central canal. Pressing into the central canal can have serious consequences but yours seems pretty mild from the language in the MRI' If I could show you my MRI it is not minor, the spinal fluid is practically non-existent through pressure from the C3-C7 through what I can only describe as fluid choking. But I don't expect you to know that and perhaps my foreign NHS radiologist wasn't one for words!

    You were spot on from when you said 'But from your description of symptms I'm not sure that is the cause. It's more likely the compression of the nerve roots.'

    Where you said 'The consensus of my Drs is that if there is not definite compression on the cord with myelopathic symptoms (gait disturbances, weakness, incoordination, bladder symptoms reflex changes), conservative approaches are warranted' I have had peripheral neuropathy for some years now, just no-one thought to look into why! Over the last few years, I have had problems with coordination, bladder continence and bowl spasms, cramps as well as a stiff neck.

    All my GP's did at the time were blood tests and more or less assigned it all to drinking too much. Forgetting the fact I was on Warfarin (anticoagulants) and anti-depressants which were playing hell with my liver. Hence, to add to the conundrum of my current condition, I cannot take NSAIDS or any anti-inflammatory medication.

    I have since relocated to a new area, joined a new Practice and the cause of all has finally been found! I have been back in touch with my new Back Pain Specialist as after your kind definitions allowed me to talk more confidently to her. She was much more frank and admitted I have a very severe osteoarthritis where indeed the foraminal holes have diminished as a result of the osteophyte formations and are compressing the exit nerves. Good news is she will be trying to refer me as a matter of urgency.

    I am a bit worried about where it goes from here. I heed your warnings on unnecessary surgery but am a bit perplexed over how they could snything if the foraminal holes are too tight. A big nerve runs through them, can't exactly drill them bigger can they! Been looking at scientific dietary papers but don't have much hope at my stage of OA. Anything you have tried and helped? Bearing in mind my need for Ac's?

    jeez, do I write! Once again Chuck, Thanks

     
    Old 06-23-2014, 03:33 AM   #6
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    Re: MRI results C4 & C6/7 thecal compression

    Right, I understood that you were in the UK. In general, your spinal cord can take quite a bit of compression (30 - 50% in some studies) before you have symptoms of myelopathy. There are places in my MRI, for instance, that have essentially no fluid around the cord but I do not have certain myelopathy symptoms so far. Often, MRIs will include measurements of the spinal canal diameter which can make it easier to understand the degree of compression but yours does not include that information.

    However, this is all very individual. If you are having coordination problems (and especially bowel/bladder issues), that could possibly be due to myelopathy and only a spine specialist will be able to figure that out. Does your pain specialist know you suffer from these symptoms (especially the bowel/bladder issues)? This may help her get you a more urgent referral. If these issues are due to myelopathy cord compression causing trauma) then surgery may be your only option. It is unfortunately, not uncommon to have both myelopathy and radiculopathy (the radiating pain from the nerves being compressed).

    If it is only radiculopathy, then there are often other possible conservative treatments to try first. If surgery is recommended, in one of the most common procedures, they essentially do drill out the holes. One of my surgeons described it almost exactly that way.

    These are all great things to discuss with the spine specialist when you see them. Also, if surgery is recommended, if possible you should try to get more than one opinion. Different surgeons have different ideas, techniques etc and you'll want to feel comfortable with your treatment plan.

     
    Old 07-01-2014, 01:24 AM   #7
    Cindyrelli57
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    Re: MRI results C4 & C6/7 thecal compression

    Chuck you seem extremely knowledgeable, perhaps you can help me with my MRI results, C5-C6 left paracentral disc protrusion with annular tear is seen again and has progressed in the interval, now causing effacement of the thecal sac and mass effect upon the ventral aspect of the left hemi cord. I had a fall in July of 2008 and that is when my back issues began, I have other disc bulges, protrusions, in my thoracic spine and lumbar but at the moment they are not causing the significant pain that my c-spine is. I have gone through a lot of physical therapy over the last 6 years without any relief. My neuro surgeon wants me to have a anterior cervical discectomy and fusion using a ROI-C cervical cage. At this point I am willing to try anything since over the years my issue is only getting worse. I lost my daughter in 2008 and have been raising my grandson since then. He is 15 now and I want to be active, energetic, and beable to function normally. What is your opinion on this type of surgery?

     
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