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    Old 07-28-2014, 11:26 AM   #1
    Moonstar22
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    C-spine MRI question

    In the results of my MRI he wrote "Small central disc protrusion and annular disc osteophyte complex at C6-7"

    I sort of understand the protrusion part of this but the rest...I'm confused.

    C4-5 and C5-6 were fused 2 1/2 years ago.

    Can anyone explain what this means?
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    Old 07-28-2014, 01:08 PM   #2
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    Re: C-spine MRI question

    Means you now have a bulging disc and bone spurs around the bones supporting said disc, below your fusion. Annular means circular, osteophyte means Bone spurs.
    They say you can suffer future herniation's above or below a prior ACDF.
    I am about to have a second ACDF surgery c5-6 c6-7 due to a prior ACDF of c3-4 c4-5 causing the below disc which was bulging is now herniated and pressing on the nerves causing my right arm to go numb and stop functioning like it's suppose to. If you're not having problems it's nothing to worry about.

     
    Old 07-28-2014, 01:59 PM   #3
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    Unhappy Re: C-spine MRI question

    Quote:
    Originally Posted by Ruffdogster View Post
    Means you now have a bulging disc and bone spurs around the bones supporting said disc, below your fusion. Annular means circular, osteophyte means Bone spurs.
    They say you can suffer future herniation's above or below a prior ACDF.
    I am about to have a second ACDF surgery c5-6 c6-7 due to a prior ACDF of c3-4 c4-5 causing the below disc which was bulging is now herniated and pressing on the nerves causing my right arm to go numb and stop functioning like it's suppose to. If you're not having problems it's nothing to worry about.
    Thanks Ruffdogster,
    I appreciate the info. Yes I am having problems with neck pain and tingling & numbness. Just like before the 1st surgery in 2011. That is one of the reasons for recent MRI's I had. To find out what's going on in my neck. I am worried I'll need another surgery and it upsets me too because the Dr I went to was a Ortho & he said to do all 4 levels. The Dr that did the surgery was a Neuro
    and told me he'd rather just do the 2 at that time due to the range of motion I would loose and that I may or may not ever need another surgery.

    Now I know that I have another problem to deal with! It just seems endless.
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    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

    Last edited by Administrator; 07-28-2014 at 05:55 PM.

     
    Old 07-28-2014, 03:10 PM   #4
    Ruffdogster
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    Re: C-spine MRI question

    I am no Doctor, but I'm glad my Ortho only wanted to do 2 levels only and see if that does what he expects. I had the upper two discs flattening the spinal cord, so that was a priority. I breezed through that surgery and I am hoping this one is the same, since he has to remove all the old hardware from the first surgery, because it can't be reused.
    In your case you are starting to experience the symptoms I did after my surgery, but in my case the arm problems came on suddenly. As in the last 3 mo. and my surgery was in 2012.
    Only you can determine how much pain to endure, me I need my arm to function so I am having the surgery to try and get it back.
    Good luck to you keep us posted

     
    Old 07-28-2014, 03:30 PM   #5
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    Re: C-spine MRI question

    Yes your right, if there is enough pain I will have to but more important is if anything is on the spinal cord. I have tingling in my fingers All the time and numbness in hands and arms. Left is worse and at times I have trouble writing. I've had this b-4 and after surgery which my Nero Dr says is nerve damage. The pain in my neck is being helped with the meds I take from my back surgery. The weird part this time is that sometimes my head feels like it weighs 500 lbs. and I can't hold my head up and have to lay down.

    I just went thru a horrible surgery on my lumbar L1 to L5 and am currently going to 3 other specialists that my Ortho Dr is sending me to, to try to find out what's going on in my whole spine so...we'll see what happens.
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    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

     
    Old 07-28-2014, 03:42 PM   #6
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    Re: C-spine MRI question

    I'm not a Dr either but from all the Drs I've talked to a 4 level ACDF is a big deal. One study I read suggested fusion rates of 65% with a 4 level ACDF vs. 97% with a single level, recovery is longer, other complications higher etc. Also, what you have going on is called adjacent segment disease where levels around the fusion degenerate due to extra stress placed on them by the fused vertebrae. This occurs in roughly 26% of 1 or 2 level ACDFs over 5 years according to another study. So, it's a calculated risk either way.

    The other thing is that these degenerations may or may not require further treatment. Did the MRI mention that the pathology at c6-c7 is pressing on either the nerve roots or the central cord? If not you'll definitely want to have a discussion with your spine surgeon about what could be causing your symptoms. You may also want to discuss alternatives to surgery which are often very successful in treating the type of symptoms you describe. If surgery is indicated you may also want to get an opinion from your surgeon (or another qualified one) about alternatives to ACDF. One of the surgeons that I talked to is a sort of pioneer in disk replacement surgeries (he recently did the first 2 level disk replacement surgery on the west coast). He was saying that even with a previous multiple level fusion it would usually be possible to have replacement surgery which is generally less invasive.

    Good Luck...

     
    Old 07-28-2014, 03:52 PM   #7
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    Re: C-spine MRI question

    You're reply came in as I was typing mine . RE: cervical and lumbar spine issues : A large, multi-institutional study found that ~40% of people with cervical spine issues also had lumbar spine issues without explanatory disease processes (like Ankylosing Spondylitis) so I guess that is pretty common. I, fortunately, do not.

    I did, however, have the 500 pound head thing. This fortunately went away with some combination of steroids, PT and traction.

     
    Old 07-28-2014, 04:00 PM   #8
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    Re: C-spine MRI question

    Quote:
    Originally Posted by ChuckStr View Post
    I'm not a Dr either but from all the Drs I've talked to a 4 level ACDF is a big deal. One study I read suggested fusion rates of 65% with a 4 level ACDF vs. 97% with a single level, recovery is longer, other complications higher etc. Also, what you have going on is called adjacent segment disease where levels around the fusion degenerate due to extra stress placed on them by the fused vertebrae. This occurs in roughly 26% of 1 or 2 level ACDFs over 5 years according to another study. So, it's a calculated risk either way.

    The other thing is that these degenerations may or may not require further treatment. Did the MRI mention that the pathology at c6-c7 is pressing on either the nerve roots or the central cord? If not you'll definitely want to have a discussion with your spine surgeon about what could be causing your symptoms. You may also want to discuss alternatives to surgery which are often very successful in treating the type of symptoms you describe. If surgery is indicated you may also want to get an opinion from your surgeon (or another qualified one) about alternatives to ACDF. One of the surgeons that I talked to is a sort of pioneer in disk replacement surgeries (he recently did the first 2 level disk replacement surgery on the west coast). He was saying that even with a previous multiple level fusion it would usually be possible to have replacement surgery which is generally less invasive.

    Good Luck...
    Here is what the MRI report says

    There are no relevant examinations for comparison. The patient is status post
    cervical fusion at C4-C5 and C5-C6.. There is a susceptibility artifact from the
    metallic fusion. At C3-C4 there is however a central disc herniation with
    ventral impression on the cervical cord. There are no significant cervical cord
    signal abnormalities in this location. There is also suggestion of bony right
    neural foraminal encroachment. No other areas of cervical cord compression are
    identified. There is mild central spinal canal stenosis at C5 and C5-6 levels
    with mild right-sided bony neural foraminal encroachment at C5-C6. A small
    central disc protrusion and disc osteophyte complex is suggested at C6-C7
    without significant mass effect on the cervical cord.

    Impression:
    1. Status post anterior fusion at C4-5 and C5-6 levels
    2. Central disc herniation at C3-C4 with mild ventral impression on the cervical
    cord.
    3. Small central disc protrusion and annular disc osteophyte complex at C6-7.


    ***************************
    Maybe you can figure this out & let me know your thoughts. I know no one is a doctor on this forum but any advice or suggestions are welcome
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    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

     
    Old 07-28-2014, 04:10 PM   #9
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    Re: C-spine MRI question

    Ruffdogster & ChuchStr

    Not only cervical but there seems to be a thoracic problem too. Here is that MRI report....any comments...please do

    Anterior cervical fusion is again identified at C4-5 and C5-6 levels. At T6-T7
    there is a right paracentral disc protrusion with ventral impression on the
    thecal sac. At the T6 level there is dorsal impression on the thoracic cord with
    loss of volume of the thoracic cord which is felt to reflect a cystic structure
    demonstrating signal characteristics which follow CSF. This may reflect an
    intradural extra medullary thoracic arachnoid cyst. A small disc osteophyte
    complex is noted at T7-T8 with minimal ventral impression on the thecal sac
    without spinal canal stenosis. The remainder of the thoracic spinal canal is
    unremarkable. No significant thoracic cord signal abnormalities are identified.

    Impression:
    1. There is dorsal mass effect on the thoracic cord at the T6 level which
    appears to be secondary to an oval cystic structure 2.2 cm in length and 7 mm in
    diameter possibly reflective of an intrathoracic intradural extra medullary
    arachnoid cyst. There is some loss of volume of the thoracic cord at this level.
    Additionally there is a component of ventral impression on the thoracic cord at
    the T6-T7 level secondary to a right paracentral disc protrusion
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    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

     
    Old 07-28-2014, 05:05 PM   #10
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    Re: C-spine MRI question

    A few things jump out :

    The herniation at c3-c4 appears to be much more of a concern (than c6/c7) since it is pressing on the spinal cord although only mildly. Also mentions some foraminal (nerve root) encroachment but unfortunately not the extent. Hard to gauge the significance.

    The fact that there is degeneration at the area of your fusion (C5/C6). That is strange since the point of a fusion is to prevent that from happening and lend stability. The radiologist also mentions mild central stenosis (something is pushing into the spinal cord canal and narrowing the space), but doesn't say what's causing it. I would follow up on that with your surgeon.

    As far as your symptoms, where is the numbness and tingling? That might help determine if the problem is coming from c3/c4 or from something going on with the fusion (at c5/c6).

    As far as your thoracic MRI, the most significant finding is something that looks like a cyst (to the radiologist anyway). It appears this is pressing on the back of your spinal cord enough to alter the volume. Do you have any symptoms with your legs, balance, coordination, bladder/bowel issues etc? That would indicate an urgent problem. At any rate you'll want to discuss with your surgeon the management and treatment if any for the cyst. The rest of the findings have to do with the thecal sac which is the membrane around the spinal fluid and the spinal cord. Impression into this typically isn't dangerous until the cord itself is impacted.

    Adjacent segment disease does occur in the lumbar and thoracic spine as well. That *may* account for the problems in your thoracic spine, although if the cyst is really an arachnoid cyst, those are congenital.

     
    Old 07-29-2014, 02:21 PM   #11
    Moonstar22
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    Re: C-spine MRI question

    Quote:
    Originally Posted by ChuckStr View Post
    A few things jump out :

    The herniation at c3-c4 appears to be much more of a concern (than c6/c7) since it is pressing on the spinal cord although only mildly. Also mentions some foraminal (nerve root) encroachment but unfortunately not the extent. Hard to gauge the significance.

    The fact that there is degeneration at the area of your fusion (C5/C6). That is strange since the point of a fusion is to prevent that from happening and lend stability. The radiologist also mentions mild central stenosis (something is pushing into the spinal cord canal and narrowing the space), but doesn't say what's causing it. I would follow up on that with your surgeon.

    As far as your symptoms, where is the numbness and tingling? That might help determine if the problem is coming from c3/c4 or from something going on with the fusion (at c5/c6).

    As far as your thoracic MRI, the most significant finding is something that looks like a cyst (to the radiologist anyway). It appears this is pressing on the back of your spinal cord enough to alter the volume. Do you have any symptoms with your legs, balance, coordination, bladder/bowel issues etc? That would indicate an urgent problem. At any rate you'll want to discuss with your surgeon the management and treatment if any for the cyst. The rest of the findings have to do with the thecal sac which is the membrane around the spinal fluid and the spinal cord. Impression into this typically isn't dangerous until the cord itself is impacted.

    Adjacent segment disease does occur in the lumbar and thoracic spine as well. That *may* account for the problems in your thoracic spine, although if the cyst is really an arachnoid cyst, those are congenital.
    Thanks Chuck, you've explained a lot. I don't have an appt. with my surgeon until Aug. 13 and will be sure to go over everything in detail with him.

    Yea, the numbness & tingling in my arms & hands never go away & most of the time it's worse in the left and my wrist hurts too.

    As for the other symptoms you asked about, I do have some pain & numbness in the upper thigh areas, as well as numbness in the bottom part of my left butt. My gait it totally off so yes I have problems with balance & coordination. I can't walk without my cane. As for bladder & bowel yes that too. Sounds sad doesn't it? I just saw a Gasto Dr due to bowel issues & he said I have nerve damage. I will see a Urologist on Aug 5th. This Friday I see A Neuro. Dr.

    None of it sounds too good. I'm just falling apart. Very depressed.
    Thanks again for your input, you are very helpful.
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    DLIF L1 to L5 Dec 2013
    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

     
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