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  • Please help me understand my husband's MRI.

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    Old 10-17-2014, 06:47 AM   #1
    Mimij4554
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    Please help me understand my husband's MRI.

    This cervical MRI is in f/u to x rays obtained over the last year and a half. Pain has continued to worsen, and is intensified by prolonged sitting, riding in a car, or really just anytime without a position change. We are waiting on the MRI of the Lumbar region, and we know our next step is pain management.

    Symptoms include: numbness in left thigh, partial numbness in left foot, tingling sensation in hands, legs and feet. Some numbness in fingertips. He is unable to sleep through the night, even with OxyContin . He usually awakens from the pain and sits up for a couple of hours after Advil until he is comfortable enough to return to bed. Pain medication has progressed from Advil, Valium, flexoril, Hydrocodone, and now OxyContin at bedtime. He is 65, and retired in April because his job required extensive travel, which he just can't do any more. He traveled extensively by car and plain all of his working years, and we are wondering if all that sitting has contributed to his condition. Is if feasible that at this time, he is unable to travel long distances, not to mention the effect that OxyContin has on his reflexes. He has great difficulty with bending over. He is also involved in a terrible divorce, with an idiot judge that has found his condition not creditable. I guess they were giving out medical degrees at the law school he attended. We were advised to get an "expert witness" to clarify. Anyway, I need help in understanding part of this MRI.

    Mild straightening of the spine with degenerative disc disease worst. Between C5 and C7. No subluxation. No fractures or marrow edema.

    Spinal cord is normal in size and signal intensity. Included portions of the the posterior fossa unremarkable.

    C2-C3- no stenosis

    C3-C4- no stenosis

    C4-C5- small diffuse disc bulge causing mild central canal stenosis. No foraminal stenosis.

    C5-C6- Disc height loss and a right paracentral disc osteophytic protrusion causing mild to moderate central canal stenosis with more moderate right lateral recess narrowing and severe right neural foraminal stenosis. In innate spurring and facet arthropathy causes moderate left foraminal stenosis.

    C6-C7- disc height loss and a posterior disc osteophytic complex, slightly asymetric to the left causing mild central canal stenosis, and mild right foraminal stenosis and moderate left foraminal stenosis.

    C7-T1- minimal disc bludgeon but no significant central narrowing. No foraminal stenosis.

    T1-T2- Disc desiccation without central canal stenosis. T1 and T2 hyperintense lesion in the T3 vertebral body compatible with a hemangioma.

    No prevertebral soft tissue swelling. Neck soft tissues are unremarkable.

    Impression
    Moderate degenerative disc disease between C5- and C7, worst at C5-C6 with a mild to moderate central canal narrowing but severe right neural foraminal stenosis secondary to asymmetric right paracentral disc osteophytic protrusion.

    Thanks for your help!

     
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    Old 10-17-2014, 01:10 PM   #2
    ChuckStr
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    Re: Please help me understand my husband's MRI.

    You didn't mention specifically where the pain was it sounds like lower back pain, is that correct?

    To understand the MRI you need to know a little bit about spinal anatomy. In the cervical spine there are 7 vertebrae, C1 at the top of the spine around the base of your skull, through C7 roughly at the juncture between your neck and shoulders. Each pair of these vertebrae is separated by a spongy disk that absorbs impact and provides flexibility to your head/neck. The vertebrae essentially form a ring around the spinal cord referred to as the "central canal". Pairs of vertebrae meet and provide outlets for the nerves that provide sensation and motor control to the muscles, these outlets are called "neural foramen".

    So level by level you have :

    C4/C5 - "disk bulge causing mild central canal stenosis" - The spongy disk is starting to protrude into the ring for the spinal cord causing less space (stenosis). This is graded on a minimal, mild, moderate, severe scale with your husband's being mild.

    C5/C6 - "disk height loss" - As you get older or from trauma the spongy disks start to break down and become less spongy causing disk height loss. This is also known as dessication. "...disk osteophyte" - When the disks degenerate the vertebrae can rub together causing bone spurs (disk osteophytes). "...mild to moderate central canal stenosis" - the bone spurs are pressing into the ring space for the spinal cord somewhat. "... severe right foraminal stenosis" - the bone spurs are also pressing into the space for the nerve root on the right, severely in this case. This means it is likely that the right C6 nerve is being compressed. Often radiologists will note that in the report but it isn't always clear from MRI alone. "innate spurring and facet arthropy causing moderate left foraminal stenosis" - The bone spurs and arthritic changes of the joints between the vertebrae are causing moderate compromise of the space for the left C6 nerve.

    T3 - "hyperinstense lesion..." means that there is a bright spot on MRI in the T3 vertebra itself. This is most often due to a non-cancerous, slow growing tumor made of blood vessels (hemangioma). This is found in about 10-15% of middle age and older adults and rarely causes symptoms. You should discuss this with your husband's spine Dr. Usually they just monitor it and see if it correlates with any symptoms you have.

    The reset of the MRI is essentially normal.

    I'm not a Dr, but I don't see anything in the MRI that would account for the low back and leg symptoms your husband is experiencing. It is possible for cervical spinal canal stenosis to cause some of these types of symptoms but the mild to moderate canal stenosis doesn't sound severe enough to be causing those problems. The severe right foraminal stenosis at C6 could very well be symptomatic. I would expect sensory problems (pain, numbness, tingling) in the right arm and into the thumb of the right hand as well as possibly weakness and/or atrophy there. These MRI findings must be taken in context with symptoms and clinical examination by a spine specialist to determine how the issues on MRI may or may not be causing your husband's issues.
    My guess is that the lumbar MRI may be more illuminating as to the source of the low back and leg symptoms your husband is having.

    If I were your husband I would not immediately jump into any type of pain management. I would get under the care of a spine specialist, fellowship trained orthopedic surgeon or neurosurgeon dealing only with spine issues. They can help come up with a reasonable treatment plan which may include pain medication, but may also include other modalities such as physical therapy, e-stim, etc.

    Good luck and let us know how it goes...

     
    Old 10-17-2014, 04:27 PM   #3
    Mimij4554
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    Re: Please help me understand my husband's MRI.

    Pain is really bad in neck, particularly with motion or trying to sit at a computer. He does have numbness and tingling in arm and fingers. The x rays of the lumbar also show degenerative disc disease, and that MRI is on Sunday. He has been followed by the same MD for 2 years, and we have a meeting on Tuesday to discuss both MRI's and the treatment plan. I know pain is a subjective thing, but he isn't a complainer and it really hurts me for him to be so uncomfortable. Thank you for your kind reply!

     
    Old 10-17-2014, 05:11 PM   #4
    ChuckStr
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    Re: Please help me understand my husband's MRI.

    Pain in the neck and numbness and tingling in the arm and fingers especially on the right side matches the problems at C5/6 mentioned in the MRI.

    If the MD is not a spine specialist (ie. fellowship trained neuro or ortho surgeon that does only spines), I would consider seeing one. They are the experts in evaluating all the diagnostics and suggesting appropriate treatment. They will also be able to judge whether or not your husband has reached the point that conservative treatment won't help. My GP is a great guy and Dr, but I wouldn't (and don't) trust him with something like that.

    If your husband is at the point he requires something like Oxycontin he needs to get on an appropriate treatment plan as soon as possible. I know from experience how debilitating that kind of pain can be.

     
    Old 10-23-2014, 07:51 PM   #5
    teteri66
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    Re: Please help me understand my husband's MRI.

    Did you meet with the doctor? What does he suggest for a plan of treatment?

     
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