[kenk2010]

Hi, I'm a 45 yo male and I was recently diagnosed with Degenerative Disk Disease. I had been experiencing lower back and neck pain for a few years but recently it has become intolerable.

I've been getting weakness/numbness in my legs and arms and have been getting headaches that won't go away. My family doc did an xray and it showed a narrow space between C5-6 and mild end-plate spondylosis. It also showed Uncovertebral Hypertrophy. The xray report failed to show any findings for my thoracic/lumbar spine. He put me on Prednisone and Ultram (50mg 3x/day) that did nothing for my symptoms. He then had me do an MRI of my Lumbar and cervical spine.

I got those results today and I would like some help deciphering them before I go see the Orthopedic back surgeon in September. I tried doing some research on the internet and have found some useful information but I would like some input as to what I might expect from my MRI findings. I'm fairly certain surgery is going to be an option and if it is, has anyone had simular MRI findings and had surgery for it? If so, what type and how have you progressed?

Here are my MRI findings. If anyone can help interpret them I would much appreciate it. I know the Ortho surgeon will discuss all my options, but I would like to go in with as much information as possible.

Thank you for any help you can provide!
Ken

Cervical Spine MRI Findings:

C4-5 Right and left posterolateral disk bulge with prominence of the posterior margins of the uncovertebral junctions. This midly narrows the lateral recesses bilaterally at C4-5. No central canal spinal stenosis is seen.

C5-6 Mild to moderate narrowing and signal loss is present. There is a moderate sized central broad based disk herniation. This is associated with moderate spondylosis and bilateral foraminal stenosis. This is in a moderate degree.

Impression:
1. Moderate narrowing and signal loss at C5-6 wih a moderate sized broad based disk herniation at C5-6 with evidence for moderate spondylosis with bilateral foraminal stenosis.
2. Right and left posterolateral annular disk bulges with prominent posterior uncovertebral joints at C4-5. This gives rise to bilateral mild to moderate foraminal narrowing.

Note: At C5-6 there is a mild central canal spinal stenosis and mild deformity of the anterior aspect of the cervical spine at this level.

Lumbar Spine MRI Findings:

T12-L1 Moderate narrowing and signal loss is present. There is a moderate posterior spondylosis. Anterior osteophytes are present. There is good preservation of the central neural canal and neural foramina.

L1-2 Mild narrowing and signal loss. No herniation or protrusion is seen.

L4-5 There is signal loss here. There is a right extra spinal disk protrusion here, which abuts and slightly displaces the exited right L4 nerve root, however no foraminal stenosis is seen.

L5-S1 Mild narrowing and signal loss present. There is a small to moderate size disk herniation, but without significant deformity of the thecal sac. Slightly more prominent left central component is noted. Mild to moderate facet arthropathy noted. The central neural canal are well maintained. No foraminal stenosis.

Impressions:
1. Small/Moderate size central disk herniation at L5-S1 with a slightly more prominent left central portion. No significant mass effect seen on the nerve roots or thecal sac. Mild facet arthropathy noted.
2. Subtle right extra spinal disk protrusion at L4-5, which abuts the exited right L4 nerve root.
3. Other degenerative findings as above.

[Sheri_TOS]

Ken -

I'd had numerous MRI's of my entire spine and have never seen the comment "signal loss". I don't think this is good. I do have moderate bilateral stenosis at C5/C6 and have had it for at least 4 years. I was advised to have surgery 4 years ago but have been able to manage the symptoms so far. My NS said that stenosis will not go away and that conservative treatment will not help the situation. I have found conservative treatment to be beneficial in managing the symptoms but I also know surgery is coming up soon than later as the symptoms are being more frequent and more severe.

Good luck with your appointment! I know you have to wait until September.

[Leesa]

Hi Ken ~ The signal loss means that the nerves are being compressed so that the signal isn't being carried from the cord to the legs, the cord to the thoracic, and the cord to the cervical. That is why you feel numbness, weakness, and headaches.

You also have bone spurs in the cervical and the thoracic. Just thought I'd point that out.

God bless and best of luck to you. Take care. Hugs, Lee

[kenk2010]

Thanks for replying! You have answered a few of my questions I had and when I go see my ortho surgeon I'll be a little more prepared.

I noticed that alot of people have neurosurgeons do their back surgery, is this something I should look into as well? My family doc set me up with a back surgeon so I'm hoping I'm seeing the right doc.

Thanks again for your input!
Ken

[Leesa]

Well, a back surgeon can be a Neurosurgeon OR an orthopedic surgeon. I call my neurosurgeon a back surgeon, so it all depends on what your doctor's specialty is. Do you have any idea??? A "back doctor" is NOT a specialty. There's no such thing as a "back doctor." He's either a Neurosurgeon or an Orthopedic Surgeon.

Just as long as he's good, I guess it doesn't make any difference. I prefer neurosurgeons just cause they've been trained more in the central nervous system. An orthopedic surgeon has been trained more in the bones. It's your choice. Best of luck. Hugs, Lee

[kenk2010]

Thanks Leesa!

Guess I should have been more specific. I'm going to see an Orthopedic surgeon who specializes in back surgery. I guess he's good as it's taking me almost 2 months to get in to see him.

My appointment is on Sept. 8th so I still have a few weeks of waiting. We're limited on the doctors we can see up here in our area so finding a different one isn't much of an option.

Thanks again for replying!
Ken

[kenk2010]

Hi All.

Just wanted to update you on what the ortho surgeon said. I wasn't overly impressed with him. My appointment was at 10AM today, got there 10 min early.Because I'm a self-pay patient they took me to the back office to take my money before they even checked me in. Sat for over an hour before I got called back to the exam room. Then the nurse asked what I was being seen for. Told her my back and neck needed to be evaluated.She informed me that the doc would only examine one thing, either my back or neck and I had to choose which one I needed looked at first.I told her my neck so had to fill out a different questionaire.While I was filling it out this P.A. came in and grabbed the form from me and started filling it out.He said the doc was on a tight schedule and didn't have time to wait.He filled out the form, did a quick exam, looked at my M.R.I. and said he's going to recommend an epideral with steroids and nerve block in combination with physical therapy.He left me, I sat for another hour before the real doc came in.He sat down, took a cursory look at the M.R.I. and said he wants me to get an injection and do P.T. and see him back in 2 months. He left the room in less than 5 minutes without me even getting to ask 1 question.The first thing he told me was surgery is expensive and that I couldn't afford it.Excuse me??? Anyhoo,I think it's time to find a different doc.Unfortunetly I was sent to one that is a network doc for the clinic I go to so I didn't have much choice.Now I have to go back to him in a month to get my back looked at and shell out even more money for a visit he could have easily done today.Can someone say money hungry doc?

My question is, has anyone had a successful nerve block with steroid injection followed by P.T.? The P.A. did show me where the disc bulge is pressing on my spinal cord and intruding on the forminal processes so I don't see how P.T. and shot will fix the problem other than wasting more money.

Sorry for the long-winded post but needed to vent.I'm very frustrated at the way the doc handled things today and maybe someone here can give me some insight to what this doc is trying to do.

Thanks,
Ken

[Leesa]

Hi Ken ~

This is just MY experience ~ I've had SEVERAL epidurals and trigger points because I went to 3 different pain clinics ~ NONE of these injections did me one lick of good. But they sure did the DOC'S alot of good because they get $l,500 for injecting you!!!! And one thing ~ if the FIRST injection doesn't work, DO NOT let them fool you into getting another one. They LOVE to tell patients that they have to "build up" in the system. That is B.S. Even the medical journals say that either the first one works or none of them work. Just look up epidurals on the net.

Now if your SPINAL CORD is being impinged, WHY didn't he recommend surgery? Are you SURE he said the spinal CORD?? That's an AWFUL BIG bulge if he did. Usually a HERNIATION will be the one to impinge the cord, not a bulge.

You need to see someone else - even if you have to pay for the visit yourself. You need to see a Neuro-spine doctor. Someone who specializes in spinal surgery. Maybe an Orthopaedic surgeon who specializes in spines. But SOMEONE who knows what they're doing, and can spend some time with you. I wish you the best of luck. Sometimes chronic pain is a big-game hunt! LOL. God bless. Hugs, Lee

[kenk2010]

Thanks Leesa!

The Doc I saw yesterday was a Orthopedic Spine doc, only he used his P.A. to do the diagnosis. There are only 2 places in my area that even deal with back issues and they both only have one spine doc so my choices are rather limited. I'm waiting to hear back from the other clinic to see if they can get me in.

The MRI clearly showed the disc pushing into my spinal cord.The side view showed about about 25% compression at the C5-6 vertebra.The MRI cross section showed the disc protruding into the spinal canal and into the forminal processes which is why I'm skeptical as to the logic behind P.T. and epidurals.The surgery center that is going to do the epidural is connected to the hospital that has the spinal ortho surgeon so there is definetly a financial gain for them for me to go thru the epidurals and then perhaps 6 months down the road spinal surgery.They have quite the racket going on!

Anyway, thanks for your input! I'm definetly getting a second opinion.I didn't get a good vibe from this doctor and hopefully the next one I see will at least spend more than 5 minutes in the exam room with me.

Best regards,
Ken

[kenk2010]

Ok, just got off the phone with the other Spine Center. I faxed them my records and MRI/X-Ray reports and the doc there wants to see me first thing Monday AM (his first available appointment wasn't until 1 Nov). From what the nurse told me, injections usually aren't used to treat herniated discs that are protruding into the spinal canal, which mine is. Needless to say, looks like I found a doc who is willing to take a second look at me and decide if the epidural is the right thing to do.