[Melosgirl]

A day of overexertion in the garden has resulted in 3 weeks of neck/upper back pain, radiating down back of right arm, right arm and hand weakness, tingling right hand with numb thumb, index and middle finger. MRI was performed last week. Can anyone translate this into layman's terms? All responses appreciated!

Multi-plane and multi-sequence MRI of the cervical spine is performed without contrast. The patient had radiographs of the cervical spine 6/18/13/

FINDINGS: There is straigtening and minimal reversal of the normal cervical lordosis. There is no cervical spine compression fracture. There is a T1 and T2 hyperintense lesion in the left aspect of the T2 vertebral body, which loses signal on inversion recovery imaging felt to reflect a hemangioma.
The craniocervical junction is open. The Atlantic-dental interval is maintained.

C2-C3 level demonstrates minimal bony ridging, and uncovertebral hhypertrophy, bilaterally. There is no significant spinal canal stenosis or foraminal encroachment.

C3-C4 level demonstrates facet and uncovertebral hypertrophy, with mild biforaminal encroachment but no significant spinal canal stenosis.

C4-C5 level demonstrates bony ridging, and asymmetric facet and uncovertebral hypertrophy with severe right sided foraminal encroachment, and mild left sided foraminal encroachment. There is mild ventral effacement of CSF but no significant spinal canal senosis at this level.

C5-C6 level reveals diffuse disc bulge, bony ridging, facet and uncovertebral hypertrophy, with very mild spinal canal stenosis circumferentially. There is severe biforaminal encroachment.

C6-C7 level reveals facet and uncovertebral hypertrophy, with minimal foraminal encroachment and no significant spinal canal stenosis.

T1-T2 level reveals bony ridging, and facet hypertrophy, with moderate right and mild left sided foraminal encroachment. There is no significant spinal canal stenosis.
There is no pre or paravertebral soft tissue swelling. On sagittal T2 and FLAIR imaging, although less well seen in the axial plane, there is increased signal within the C5-C6 cervical spinal cord, perhaps an area of myelomalacia. Post-Gadolinium imaging may be considered, as clinically indicated.
There is mild generalized diminished T1 marrow signal, in the cervical spine, which may reflect red marrow reconversion. Please follow up clinically. There is no bone marrow edema. There are mild end plate changes C5-C6 level.

IMPRESSION:

1. Straightening and minimal reversal of the normal cervical lordosis.

2. Bony facet and uncovertebral hypertrophy, and bony ridging, resulting in multi-level severe foraminal encroachment, most notable right C4-C5 level, bilateralC5-C6 and C6-C7 levels, with spinal canal stenosis, mild at C5-C6 level. There is also asymmetric right sided foraminal encroachment, in the upper thoracic region as described.
On sagittal T2 and FLAIR imaging, although less well seen in the axial plane, there is increased signal, within the C5-C6 cervical spinal cord, perhaps an area of myelomalacia. Post-Gadolinium imaging may be considered, as clinically indicated. There is no evidence of cervical spinal cord compression

3. Mild generalized diminished T1 marrow signal of uncertain etiology. Red marrow conversion is a consideration. Please correlate and follow up clinically.

4. The remainder of the findings are as described above.

[Leesa]

Hi ~ I'm so sorry I haven't responded til now -- I've been sick. I'll try to help.

The straightening of the cervical lordosis means your neck is straighter than normal. This is usually caused by muscle spasms. There's a lesion at T1-T2 in the left aspect of T2 which appears to be a hemangioma -- this is a benign tumor of blood vessels that typically occur as purplish/reddish elevated area of tissue.

C2-3 minimal bony ridging, uncovertebral hypertrophy bilaterally - this means overgrowth of bone on both sides.

C3-4 Facet and uncovertebral hypertrophy. The facets are the 'wing-like" structures on both sides of the spinal cord, and you can see and feel them if you hunch your back over. So there is bony overgrowth on both sides. There is also mild biforaminal incroachment. The foramen are the holes that the nerves pass thru to get to the spinal cord. These are becoming narrow.

C4-5 bony ridging, asymmetric facet and uncovertebral hypertrophy with SEVERE right sided foraminal encroachment and mild left sided foraminal encroachment. There is mild front effacement (wiping out) of the CSF (cerebral spinal fluid) but no spinal canal stenosis.

C5-6 Diffuse (spread out) disc bulge, bony ridging, facet and uncovertebral hypertrophy (see above) with very mild spinal canal stenosis (narrowing of spinal canal. There is SEVERE biforaminal encroachment.

C6-7 Facet and uncovertebral hypertrophy, minimal foraminal encroachment

T1-2 Bony ridging, facet hypertrophy moderate right & left foraminal encroachment.

Impression - There is increased signal in C5-6 which may indicate myelomalacia. This is a softening of the spinal cord due to bleeding/injury. This should be followed up clinically.


Again, I'm sorry I took so long to respond. I wish your doc had done this WITH AND WITHOUT, but oh well.

I would ask your doc to refer you to a NEUROSURGEON. Take your films and the report to this Neurosurgeon for an opinion. You need to find out what he thinks. IF he mentions surgery, get 2 MORE opinions from other neurosurgeons. You NEVER take one doctors opinion! EVER. See what all 3 of the think and then you can make an educated decision.

First you must know that surgery is NOT for pain. Surgery is only for mechanical problems. Usually after surgery, you're left with the same pain or worse. Some people are lucky, and their pain is eased AT FIRST -- but after awhile, their original pain comes back with a vengeance. Also, there is the "Domino Effect." This is where the levels above/below the surgery site fail. That's because they have to take on more of the load. So that means more surgery. And after THAT level has been repaired, the levels above/below THAT surgery site fail, and that means more surgery - and on and on and on. It's a vicious circle.

So spinal surgery is something you must think very carefully about. It should be a LAST RESORT after ALL CONSERVATIVE METHODS have been exhausted! That means lots of physical therapy, and anything else they have to offer, perhaps even the Spinal Cord Stimulator! I've had that implanted but unfortunately due to other problems it had to come out. But it works great for pain for most people!!!

So please -- get at least opinions from other Neurosurgeons and see what they say, okay? And let us know what happens! God bless and please take care. Hugs, Lee