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    Old 03-10-2015, 09:47 AM   #1
    Hollykins1
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    Question Confused about MRI/Doctor visit

    Hello all,

    I'm new to this section, but was on the MS section for awhile. I've had some symptoms where my primary doctor wasn't sure what was going on. I also have Meniere's Disease and had a vestibular neurectomy in 2010 which complicates things.

    I have some pretty severe balance issues. Always blamed that on the Meniere's and the fact that I never seemed to really regain my balance after the surgery. It had started getting better and then got steadily worse. Has been bad in the last year, with it being very bad since about August.

    I fall quite often. Then I started noticing that my hands, mostly the left was feeling numb quite often. I drop things constantly. Fine motor skills are not good. I also trip over my own feet. Couldn't figure out why except I started realizing my left foot was doing something funny. (might be foot drop)

    I have some neck pain, and pain in the shoulders. Shooting pains in arm and leg, again mostly the left. Occasional muscle spasms in the left rib area. Tingling in the left foot, sometimes in the right one too.

    My primary sent me to a neurologist. He ordered a brain and C-spine MRI. Insurance company turned down the C-spine. Brain one came out fine, but as I was still having difficulties he pushed again for the C-Spine MRI. He said my gait was abnormal and called it Ataxia. I walk with my feet kind of far apart and wide.

    Kept getting turned down, but FINALLY the neuro got the insurance company to agree to the C-spine MRI and re-did the brain one too. Again the brain one came out fine, and the neurologist said he didn't see any sign of MS.

    BUT, he said the C-spine MRI was not good and in fact that I needed to get to a neurosurgeon asap. He said he was going to mark my referral as urgent. Now I am not sure if he was saying that because my MRI really is as bad as he said, or he was hoping to move my insurance company along to get me this referral.

    I'm going to post the text from the MRI. Some doesn't sound good, but I am not sure its THAT bad. I have the DVD of the MRI, but I can't tell anything from it.

    Since it will probably take awhile to see the next doctor, I was hoping someone here could give me some input. (I do realize you cannot diagnose) Just looking for a little more information that I can glean from the report:

    TECHNIQUE: Multiplanar sequential imaging of the cervical spine performed without intravenous contrast

    Findings:

    There is AP alignment of the cervical spine on sagittal images. There is loss of signal of the cervical intervertebral discs compatible with desiccation. Ventral effacement of the thecal sac is seen at C3-4, C5-6, C6-7. Vertebral marrow changes at the C5-6 level are compatible with discogenic degenerative changes. The spinal cord is normal in characteristics and configuration.

    The visualized posterial fossa is unremarkable.

    C2-3: No disc bulge or focal herniation evident. There is no narrowing of the central canal. The right neural foramen is patent. There is minimal/moderate narrowing of the left neural foramen secondary to osteophytic ridging.

    C3-4: There is a left asymmetric disc bulge/osteophytic ridge complex which causes minimal narrowing of the anterior left central canal. There does not appear to be abnormal flattening of the spinal cord.

    There is minimal narrowing of the right neural foramen. There is moderate/severe narrowing of the left neural foramen.

    C4-5: There is a left asymmetric disc bulge/osteophytic ridge complex which causes minimal of the anterior left central canal. There does not appear to be abnormal flattening of the spinal cord. The right neural foramen is patent. There is severe narrowing of the left neural foramen.

    C5-6: There is a diffuse disc bulge/osteophytic ridge complex at this level which causes moderate narrowing of the central canal. There appears to be mass effect on the anterior spinal cord. The right neural formen is patent. There is moderate narrowing of the left neural forman. There may be a small central focal herniation of the disc at this level as well.

    C6-7: Minimal disc bulge/osteophytic ridge complex which does not cause significant narrowing of the central canal. There does not appear to be mass effect on the spinal cord at this level. The neural foramina are patent.

    C7-T1: No disc bulge or focal herniation evident. This is no narrowing of the central canal. There is no neural forminial attenuation.

    IMPRESSION:

    Multilevel degenerative disc disease as described above. The worst level appears to be at the C5-6 disc space where there is moderate narrowing of the central canal. There appears to be mass effect on

    The spinal cord at this level with moderate narrowing of the neural foramen. There may be a small central focal herniation of the disc at this level as well.

    Thank you for looking at my post and for any help.

    Last edited by Hollykins1; 03-10-2015 at 10:35 AM. Reason: Improper spacing

     
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    Old 03-10-2015, 12:01 PM   #2
    gmak
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    Re: Confused about MRI/Doctor visit

    Hi holly, I am really sorry that you are having pain and neuropathy symptoms! Usually if the MRI shows moderate to severe nerve compression the Dr refers to a neurosurgeon to be evaluated because neurosurgeons are specialists in the spine, brain and spinal cord and nerve or cord compression can cause permanent nerve damage depending on severity so the neurosurgeon examines and determines a plan of treatment and decides if the compression will need to be relieved by surgery for nerve or cord compression or if other modalities like PT , injections or pain management is indicated. I have had 4 lumbar surgeries by a neurosurgeon that specialized in spines and I think it's very prudent to obtain the opinion of one or two spine only neurosurgeons or an orthopedic surgeon who has completed a spine fellowship. I'm glad your Dr knew a Dr to refer you to and I hope that he helps you to feel better.

    Last edited by gmak; 03-10-2015 at 12:02 PM.

     
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    Old 03-10-2015, 12:14 PM   #3
    ChuckStr
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    Re: Confused about MRI/Doctor visit

    First off, your cervical spine encompasses the first 7 vertebrae c1 at the base of your skull through c7 roughly at the bottom of your neck. Each pair of these vertebrae are separated by spongy discs made of about 90% water. Over time, the moisture content lowers (called dessication), and the disc height lowers. When that reaches a certain point, the pairs of vertebrae start to rub on one another which causes bone spurs to form. You have that in most areas of your c-spine. That isnt a big deal on its own. It really depends on where and how much the spurs grow. If they grow too much centrally they can impact the spinal cord and laterally they can affect the nerve roots. The distinction is important as cord symptoms can affect anywhere below the area of the impacted cord (a c6 cord compression can cause symptoms in your legs for instance). Compression of a nerve root will only cause symptoms where that nerve root delivers sensory or motor messages (c6 right nerve root compression may cause pain in your right shoulder but not in your legs).

    Now for specific areas of concern on your mri.

    C5/C6 - this is the area of most concern because the bonespurs at this level are pressing on the spinal cord (mass effect). It doesn't give the actual canal diameter or an idea of the extent of the compression but it does say moderate narrowing.

    C4/c5 - here the big issue is the bone spurs causing severe narrowing of the area for the right nerve root to exit. The scale is usually minimal, mild, moderate, severe, so you cant get much worse there according to the reading. Note there is some narrowing of the cord space as well but that is not at a point where it is likely to cause symptoms.

    C3/c4 - similar to c4/c5 but left nerve root exit moderate/severe compromised.

    What does this mean:
    It is *possible* the tingling in your leg, gait trouble and dropping things are due to the compression of your spinal cord at c5/c6. If that is the case, you have something called cervical spondylitic myelopathy (CSM)1. Other symptoms to look for are twitching/spasms, bowel or bladder issues, possibly weakness in limbs. It is possible your symptoms are caused by some other process as well. You'll need a good spine specialist to help sort that out.

    The pain in arm/shoulders is most likely due to the nerve roots being compressed at c4/c5 and or c3/c4. It's seems like a pretty classic case of radiculopathy (or pain radiating through the dermatome of the spinal nerve that is compressed. You can look up dermatome maps online to see how that works).

    I would get an evaluation from a spine specialist as soon as possible. This is a neurosurgeon or orhthopedic surgeon with specialized training in the spine that limts their practice to spine issues only. If it is CSM, the course is difficult to predict and there is some evidence that the longer compression remains the more likely there will be long lasting damage. They will be able to help manage the radicular symptoms and evaluate the other spinal canal narrowing as well.

    I'm amazed that the insurance company put up a fuss with your symptoms, especially with a clear head mri.

    Good luck and let us know how things go...

     
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    Old 03-10-2015, 01:56 PM   #4
    Hollykins1
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    Re: Confused about MRI/Doctor visit

    Thank you both so much for your time and thoughtfulness to reply.

    I did leave out (on here) that I am having bladder and bowel issues. And yes there is some weakness of my left arm and leg. Also I get muscle spasms on my right rib area.

    I went from just using a cane to using a rolling walker full time. My PC thought my condition was bad enough to recommend a service dog. (I am on a list)

    Oh my insurance company....sigh. The neurologist finally had to call them, peer-to-peer himself, and spent 20 minutes convincing them I needed the C-spine MRI.

    I am the type that will definitely want a second opinion. He had a doctor he wanted to refer me to, and he has an excellent reputation and education. The neurosurgeon that did my vestibular neurectomy is also top notch (and he will tell anyone that ....ha ha)

    I was just scared as the neuro is usually so laid back. I'm thinking that although I do need to see a neurosurgeon soon, it's not "urgent".

     
    Old 03-10-2015, 02:44 PM   #5
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    Re: Confused about MRI/Doctor visit

    I would reccomend going as soon as you can. If all of those symptoms you are exhibiting are due to myelopathy, it is pretty advanced. Length of time with severe symptoms is a predictor of poorer outcomes unfortunately so I'd say getting it figured out should be a priority.

    Be careful with surgeon selection. They may be great at various head surgeries for instance but if they don't specialize in spines only I wouldn't.let them touch my spine and the wont be the experts in spine treatment. You are correct that most surgeons tend to have high opinions of their.skills and that can compound this problem.

    Good luck and please let us know what you find out.

     
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    Old 03-10-2015, 02:55 PM   #6
    Hollykins1
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    Re: Confused about MRI/Doctor visit

    The doctor he is referring me to is a spine specialist, and studied at John Hopkins. Has high marks for his expertise and length of practice. Slightly lower marks for bedside manner.

    My other doctor is also listed as a spine specialist, although he also does brain tumors and the type of surgery I had. Top notch, but VERY arrogant. Although I must point out he was incredibly kind to my elderly mother who had to take me for the surgery.

    I will take all you have said to heart and be very careful with selection. Again, thank you so much for your comments. It really helps me to have clear thoughts about what I should do.

     
    Old 04-10-2015, 01:32 PM   #7
    Hollykins1
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    Re: Confused about MRI/Doctor visit

    I just went to a neurosurgeon. This wasn’t the one that the neurologist referred me to, but the one that did my vestibular neurectomy.

    Did not examine me at all, nor question me, and spent maybe a minute tops in the room.

    Said, “your neck doesn’t look that bad, nothing surgical”.

    I asked him why I was falling, having balance issues, etc., and he didn’t want to hear it. Just said, “I don’t know, maybe you are a klutz” and walked out of the room.

    Wow. Just wow. Not that I want anything to be wrong with me, but now I’m even more confused. I’m wondering if I should keep the appointment with the neurosurgeon I was referred to in the first place.

    Again, I know you can’t diagnose, but I guess I expected the doctor today to at least ask a question or two…. Am I wasting the second doctor’s time?

     
    Old 04-10-2015, 04:19 PM   #8
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    Re: Confused about MRI/Doctor visit

    The person you went to doesn't sound like a spine specialist and does sound like a jerk. Did the Dr look at the MRI images or just read the report? No serious spine surgeon would take the word of anyone else as it relates to the severity of the MRI. I would definitely go to the second Dr who is a spine specialist at a major hospital.

    There is some reason why you are having the sensory and motor issues in your arms and legs and you need to get to the bottom of it. They should probably look at a lumbar MRI as well, since a combination of cervical and lumbar spine radiculopathy fits your symptoms as well. If a "real" spine specialist concludes these issues are not related to your spine then you probably need a good neurologist (either the one you already have if qualified or a new one) to continue investigations.

    Good luck!

     
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    Old 04-20-2015, 12:00 PM   #9
    Hollykins1
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    Re: Confused about MRI/Doctor visit

    I went to the second doctor today. I liked him much better as he actually took the time to examine, ask questions and talk to me.

    He said my cervical spine wasn't as bad as the report, although there are issues. He felt that my symptoms MAY come from my back instead and wishes to get a t-spine and l-spine MRI. He is hopeful that injections might help.

    So now the fun with my insurance company.... But I do feel better that surgery is not looming over me. And I feel listened to.

     
    Old 04-20-2015, 02:23 PM   #10
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    Re: Confused about MRI/Doctor visit

    That is good news. At least now you are under the care of someone you trust and they can monitor your progress with the injections and other necessary treatment. Please do let us know how things go and if the injections are helpful.

     
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    Old 04-21-2015, 07:36 AM   #11
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    Re: Confused about MRI/Doctor visit

    Wow, that is just so annoying that the first doctor treated you that way.

    I hope you get approval soon for additional MRIs. I only have lumbar spine issues and my balance is terrible. There are many places that can affect balance.

    Please let us know if the new MRIS turn up anything.

     
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    Old 04-22-2015, 06:02 AM   #12
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    Re: Confused about MRI/Doctor visit

    Thank so much everyone. Being able to come here has made a huge difference to all the uncertainty.

    And the best information, and I hope that all who come here take seriously - find a good fellow trained spine doctor.

     
    Old 07-06-2015, 01:14 AM   #13
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    Re: Confused about MRI/Doctor visit

    Hi, I'm confused as well with my MRI reading. My symptoms are smack dab in the middle of my back to include a deep Chronic, aching pain & a painful burning sensation as well. It seems to worsen when I do any type of light housework such a as sweeping & literally puts me out of commission for no less than 24 hrs & up to 72 hrs. My doctor ordered an MRI & below are the findings. I don't know anymore now than I did before the MRI :-(

    Last edited by Mod-S4; 07-06-2015 at 10:23 PM.

     
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