cervical mri help?
 

Hello everyone.

I recently had a cervical MRI done by my orthopedic doctor and now that I have the actual report in hand (which I didn't the last time I saw him) It looks kind of scary to me and while I am generally good at looking things up and work in a health care field, I can't seem to find a lot of info on this MRI.

I will start by saying that I have had some degree of neck pain pretty much constantly for the last 8 years. My previous doctor told me that it was fibromyalgia and there was nothing he could do, I just needed to exercise more (I am quite active as it is). In December of last year, I developed pain in my back and legs that was so bad I couldn't even put my own pants and shoes in in the morning. My new PCP sent me to a rheumatologist because my sed rate and CRP were very high, and he said "the fibromyalgia diagnosis stands" and that I had a severe vitamin d deficiency, gave me 12 weeks of vitamin D pills and said he would see me in 4 months. I went back to my PCP and told her I was still in immense pain and that this was not ok, so she ordered an MRI of my lumbar area. This showed a herniated disc putting pressure on the S1 nerve root, as well as disc and facet joint arthritis. I got a steroid shot in the area and lo and behold, the vast majority of the pain was gone.

At the same time I had been complaining because my elbows hurt and my hands were going pins and needles all the time. I was sent to an ortho doc specializing in hands and arms. He said it was bilateral carpal tunnel, plus ulnar nerve irritation and tendonitis and put me in wrist braces for 2 months and told me to come back after that if it was still happening. It was, so I went back and he ordered an EMG - no abnormalities in my wrists or elbows, the neurologist suggested perhaps I had fibromyalgia. So I was then referred to an ortho doc that specialized in spines, and he ordered a cervical MRI. At this time I was also going in for my spine shot, and the pain management doc did a series of reflex tests that the neuro and ortho docs didn't do and found that I have bilateral hyper reflexes in both arms and a positive Hoffman's sign. When I went back to see the orhto doc, he said that there was a lot more damage than he expected to see for someone my age (I am 33) and that he needed me to go back to the neurologist. I am now waiting to see the neurologist again, but I have very little hope that they will say anything other than fibromyalgia now that I have somehow picked up that label (which, by the way, I do not have any of the fibro symptoms other than that I have had pain in 2 areas that has been shown to have a cause on MRI) So, 2 weeks later, I got the actual MRI report and as I said, it is scaring me a bit and I hoped I could get some feedback on it here.

MRI CERVICAL SPINE W/O CONTRAST
INDICATION
A 33-year-old female with neck pain and bilateral hand numbness.
TECHNIQUE
Sagittal T1, T2, inversion recovery, and axial 3D and gradient-echo
T2*, and T1 MR images of the cervical spine. No comparison.
FINDINGS
Cervical alignment and marrow signal are normal. There is cervical
cord abutment and increased T2 signal within the cord from C3
through C5 compatible with cervical myelomalacia secondary to disk
degeneration and ventral abutment as detailed below.
Craniocervical junctional anatomy is unremarkable as is C2-3.
C3-4 has moderate central canal stenosis with a mild posterior disk
bulge abutting and flattening the ventral aspect of the cervical
cord. Uncovertebral spurring encroaches the neural foramina.
C4-5 has moderate posterior osteophyte-disk complex and mild
uncovertebral spurring with ventral abutment, and flattening of the
cervical cord, and moderate central canal stenosis. Neural foramina
are mildly encroached.
C5-6 has mild uncovertebral spurring and mild posterior disk bulge
causing mild central canal stenosis. No cord abutment or
compression.
C6-7 and C7-T1 levels are unremarkable.
Paraspinal soft tissues and musculature are unremarkable.
Visualized posterior fossa is unremarkable. Cerebellar tonsils are
normal in position.
IMPRESSION
Moderate C3-4, C4-5 and to a lesser extent C5-6 degenerative disk
disease. Mild to moderate posterior osteophyte-disk complex and
disk bulging cause moderate central canal stenoses, primarily at C3-
4 and C4-5, with signs of cervical myelomalacia.
I suspect there is underlying degree of short pedicles and
congenital narrowing of the central canal.

xrays also show I have mild kyphosis in my neck.

The most concerning thing for me is the myelomalacia, which I can't seem to find much about on the internet. Is this as bad as it sounds? My ortho doc seemed very unconcerned about the whole thing, but did mention that they would have to surgery at some point to decompress the cord, but didn't sound like it would need to be any time soon.

Thanks!

Hi Silver,

Im sure Lessa with decfier your MRI---is very good at breaking it down in simple terms.

I dont think it looks to bad at this point most concerning is kyphosis can be a sometimes hard to treat but your case is mild. Have your tried ESI(epidural steroid injections) it might help the herinations since they dont seem to be severe one it may help calm down inflamation and allow the disc to heal. I have alot of friends and family acheive success and avoid surgery.

There in minmal procedure called lamintomy & foraminotomy that may hep with the stensis and relief myelomalacia, only if the prob is stemming from the stenosis. Usually done out patient and you home same day very quick and easy recovery for most and might help avoid fusion down the line. I think because your young I would try to be as proactive as possible. Always get 2 or 3 consults when it comes to the spine. Best wishes!!!!!

Do the drs feel your arm & hand symptoms fit with the MRI results?
If not do you do much repetitive or long time desk work, or had any previous whiplash or other neck injury?

Can you hold your arms up in the stick em up position , open & close hands? Do they get heavy, turn white, pain increased?
If so look at our Thoracic outlet syndrome forum. (TOS) for short.

If you don't have severe fatigue along with whole body aches, I don't think fibro is an issue. Some drs just say that.:(

We have a Fibro forum as well as a Medications forum - depending on the Vit D pills that were rx'd , they might have been the wrong type and not as usable by the body.
Index of forum topics-
http://neurotalk.psychcentral.com/index.php

Jo*mar - my ortho doc said that in the absence of thyroid problems or b12 deficiency that the hand symptoms could be related to the MRI findings, but that is why he is sending me to the neurologist. I don't do repetitive work, but I did have whiplash about 10 years ago - not from a mva, but I fell backward in my work parking lot because the edge of the pavement broke under me and I whipped my head around as I was trying to catch myself and sprained my neck.

As for the hands up - I can hold them up both open and closed handed, and they don't hurt, but my fingers feel hot when I hold them over my head - same feeling I get where my nerve pain was from my lumbar region since I got my spinal epidural.

I will take a look at the vitamin d - they put me on 50,000 iU's 1x er week for 12 weeks and my levels went from 14 to 12 - their solution was to put me on the same thing for another 5 weeks which is a little disheartening. I'm not even sure how it's possible for me to have vit d deficiency since I send the majority of my days outside without sunblock, but I guess that's another story entirely.

mg neck prob - I will definitely be trying as many conservative approaches as possible before surgery - I did have the epidural for my low back and it was extremely painful for me, and I couldn't walk for a day and a half after I had it. My pain dr said that she could try a different medicine that was the type they normally used for necks the next time I need one, but I am terrified to have my neck done considering how painful my back was :(

I'll try to help ~

C3-4 mild central canal stenosis (narrowing) with a mild rear disc bulge abuttment and flatting the front of the spinal cord. Spurring encroaches the neural foramina. The foramen are the holes that the nerves pass thru to get to the spinal cord.

C4-5 Moderate rear bone spurs and mild spurring and ventral abuttment and flattening of the cervical cord and moderate canal stenosis (narrowing). The foramina are mildly encroached. (narrowed)

C5-6 Mild spurring and mild rear disc bulge causing mild central canal stenosis.

Note: C3-4 and C4-5 Signs of Cervical Myelomalacia, which is spinal bleeding causing softening of the spinal cord; Hemorrhagic infarction of spinal cord can occur as a sequel to an acute injury. This should be further investigated. I would NOT let doctors take this LIGHTLY if I were you, but find someone who will investigate. Perhaps a teaching hospital. :)

Plus at C4-5 it indicates that the whole cord is flattened, not just a part of it, like at C3-4. :eek:

I definitely would want ANOTHER OPINION on this MRI. I'd go to a NEUROSURGEON if I were you. And then after that, get 2 MORE opinions! Don't rely on just one Neuro opinion. We're talking about some pretty serious issues here. So in total, get 3 opinions from Neurosurgeon, okay? And PLEASE, let us know what they say. I'd really like to know, and Im sure everyone else would too! God bless and please take care. Hugs, Lee :)

Thank you Leesa.

Do you know, is the myelomalacia indicative of a recent trauma to the spinal cord, or could it be from the whiplash I suffered 10 years ago? And how bad is having the whole cord flattened?

Well, I saw the neurologist today - he says I need surgery soon. He basically said that there is a lot of damage and if I were to fall wrong, I could become paralyzed due to the bruising on my spinal cord. He also said if I dont have surgery, I could just wake up some day partially or fully paralyzed :eek:

Going to try to get an appointment for a second opinion, but I don't know if I will be able to get in to see them in a timely fashion if I need surgery sooner rather than later :(

The myelomalacia would NOT have come from the accident 10 years ago. It would have to have been something more recent. It can be caused by a disc protrusion being forced or pressed out by some sort of trauma/accident.

Your MRI showed SIGNS of it -- it doesn't mean that you actually HAVE it -- it means that further investigation should be made. Perhaps another MRI or even a Myelogram, however I don't if a myelogram would be dangerous for you. Your doctor would know. ;)

You should still get more opinions as soon as your can. When calling for appointments, make sure the girl at the desk who makes appointments knows of the importance of getting in SOON -- that your condition warrants that you been seen ASAP.

I wish you the very best. Lets us know, ok? Hugs, Lee :)

Thanks Lee, I will keep updating. Neurologist said there is definite bruising on the cord when he reviewed the images with me today and was very sure it is coming from the degeneration in my neck plus the congenital stenosis. I basically only had room for my spinal cord when I was born and now I have less :( My GP seems to be dragging her feet on making a referral for some reason, and is making me go meet with her again tomorrow (she just saw me last week and we talked about it - the only difference is that the neurologist now says go on the surgery) I am feeling so frustrated and broke - We have already paid over $1k in copays this year and a $1.5k deductible and I had to leave my job earlier this year due to all the problems I had with my lumbar disc herniation, and at $40 a visit to these specialists I am not sure how much longer I can keep it up :(

Wouldn't it be nice if all we had to do when we were ill was to worry about getting better? =)

Boy, you're right there! I hate to THINK how much I've paid in copays this year. :( I shudder to think.

They HAVE to give you time to get other opinions. DON'T let them hurry you into the operating room. It isn't that much of an emergency. If you were having bowel or bladder problems -- and I mean SERIOUS problems -- then I'd say you might have to get right in to the OR. But it is NOt that much of an emergency, so you DO have time to get some opinions!!! Don't let them intimidate you! :mad: That's what they're good at -- intimidating patients!

You have your rights, and right now, you've got to get 2 other opinions! You can't place your LIFE on ONE guys opinion. What if he's wrong? Then you'd wish you'd seen the other 2, right?

So tell them you'll wait til you've seen the other 2. They have to give you that time. It's a smart move, and they have to respect you for that!

I know it's tough -- but I'm behind you as well as everyone else. ;) Love, Lee

Hey Dubious ~ Where did you find the high sed rate? Did I miss something? Nuts, if i missed it, I'm going to go get new glasses! :(

Show me where it is, please!!! :eek: HELP. lol Thanks. Lee ;)

Currently, my sed rate is 48 and my crp is only 13.3, but when I first went in, my sed rate was 56 and my crp was 34. I saw a rheumatologist who thought initially that I had psoriatic arthritis (psoriasis runs in my family) but he did an MRI of my hands and said that it ruled out PA, and because of all the arm pain that I had, ruled that my earlier bogus fibromyalgia dx was accurate, and that my elevated crp and sed rate was likely due to my weight (I am obese, though I have NO health problems other than my spine being stupid). I am still waiting to see an new rheumatologist, but I unfortunately live in a fairly remote area that is near a HUGE hospital and they own all the other hospitals in the area as well, so it's hard to get away from doctors that they own, and even harder to get one doc that works with another to go against what the first one says =/ I also think that seeing as many different docs as I am right now has become detrimental as none of them is getting the whole picture and each is dragging me in a different direction, and none of them seem to actually listen to me based on the notes from the visits that I read that have blatantly untrue info in them, and no one, save the neurologist, seems to be reading anyone else's notes on me. Before I had to stop working, I worked in healthcare (I am a lab scientist) so I am incredibly jaded at this point about doctors in general and how they fail to treat patients. I will not allow myself to be treated that way.

Anywho, it's also very hard for me to drive very far because that is when I have the worst pain, my husband can't take much more time off to help me, and I have a very active almost 5 year old, so I'm still working out all the logistics =)

Went to see my GP today because she insisted on an office visit before giving me a referral to a neurosurgeon. I feel like I might be...I don't know, mentally impaired, very confused or she is. The note from the neurologists office says:

Dx's
Disturbance skin sensation
pain in limb
cervical spondylosis w myelopathy

Patient has severe spinal stenosis by MRI with myelomalacia as identified by the interpreting radiologist. This is a critical situation which no doubt explains for upper extremity sensory symptoms. It is unlikely that any metabolic factors contribute to these complaints.

She is an equestrian and at risk for quadriplegia. She was counseled at length by me today regarding this fact. She tends to ride anyway. I recommend that the patient revisits (the ortho doc) for his expert advice on how best to proceed given these results.


I talked to my GP, and she said that this isn't serious, while looking at this note. She also said the only reason I am at risk of quadriplegia is because I ride horses and that everyone who rides horses is at risk for quadriplegia (I have to wonder why he bothered putting something so obvious in the note, then??) Am I completely misinterpreting this note, or is this fairly serious and I should be seeing a neurosurgeon right away? She's claiming it will likely be 6 months before I can get an appointment.

Hi Silver --this sounds like horse ---- to me-- excuse the pun (LOL). Dubious is really smart and has the clinical background of 25 plus years. I think alot more digging needs to be done in your case. Leesa correct cord compression is serious and complex matter --If i understand correctly the cause may be stemming from another condition --Im not sure. I know in my case I was spinal cord compressed all 3 consults said surgery was my only option. I was advised before surgery that a minor fender bender could leave me parlyzed. The other thing I find hard to swallow is 6 months to wait for apt. My surgeon was higly respected Harvard grad and I got my apt within 2weeks of having MRI but I did have to wait 6 weeks for surgery. I would def start calling around personally do some research to a good ortho or neuro spinal surgeon in your area.

First post, second paragraph, third sentence. I hear ya about the eyes....:rolleyes:

I should add that the sedimentation rate and CRP are relatively non-specific so by themselves they simply state there is probably a problem but does not say where or what it is. And certainly the stenosis finding in the neck is problematic. On MRI, a sagittal AP measurement of 8 mm is termed absolute stenosis and combined with + pathological reflexes, an ortho/neuro surgical consult would not be unwise. Falling off a horse, getting rear-ended or even falling in the shower could have catastrophic results. Be careful!

Surgery
 

Hi Silver, I just wanted to wish you luck. I would take Lee's advice and have a second opinion and even a third. Surgery of any kind is serious, especially back surgery so take your time and do research. There are plenty of places you can search on the internet.
Years ago my daughters boyfriend lost the feeling in his feet and after an MRI they found he had a tumor inside his spinal column. The doctors here in FL said he had a very small chance of not getting parilized during surgery. I felt so bad for him so I went on the internet and found a Dr in NY who had invented a machine for that exact surgery and was doing it on children and adults but mostly children. I overnighted his MRI's to the doctor and within 2 weeks he was in New York haveing the surgery. He came out just fine and was back to work in 6 weeks.
So please do your research and look for the best you can find, don't let anyone rush you to surgery. Best of luck in whatever you choose to do. I will keep you in my prayers.
:hug:
Katt17

Silverfae ~ You do have a problem with these doctors all belonging to the same "group" or whatever it is. But somehow, you've GOT to see a couple that aren't going to be influenced by anyone else! I know it would be hard for you, but even if you have to travel a bit farther, you've GOT to find a couple more Neuros who can look at your films, and advise you what to do!

If you can find 2 more Neuros who aren't influenced by these other jokers, you'll be better able to make an educated decision. And that's what you need to do. You've got a big decision to make here, my friend. And who knows -- perhaps you don't even need surgery -- stranger things have happened! Perhaps physical therapy would work for you!

I wish you the very best. God bless and let us know what happens. Hugs, Lee:)

Thanks so much for the info and support, everyone!

Thought I would post an update - I know a surgical nurse who highly recommended a neurosurgeon who specializes in cervical spine surgeries that just did a laminoplasty on her husband at the beginning of the year. I asked my GP for a referral which they just got sent out late yesterday afternoon - my GP's office called to tell me that this neurosurgeon is currently booking out to late September, so I figured I would not be hearing anything for a while. I got a call early this afternoon from them to schedule an appointment and they scheduled me for June 14th which I told them was my first day I was available for an appointment (I am getting ready to head out to Mexico on vacation). Apparently, they prioritize patients by urgency and they felt I need to be seen right away =/ Good I guess, but scary also. I feel like everything has been dragging and crazy slow since January, and now it is going so fast I want it to slow down a bit!

Wow, that's WONDERFUL !!! I'm so glad they got you in! I know it's scary, hon, but you've got to get this taken care of.

Don't forget to let US know what this doctor thinks, okay? We REALLY WANT TO KNOW!!! I'll be keeping my fingers cross that you don't need surgery!

God bless hon, and please take care. And for Pete's sakes, be CAREFUL on your trip! :eek: Hugs, Lee

So, I saw the neurosurgeon today for my "second" opinion - she says that I need surgery also, and wants to do a 2 level ACDF on C3-C4 and C4-C5 - she doesn't want to do the C5-C6 because of my age, and because it is not as bad (yet). She basically said that the damage I have is not something she would expect to see in a person my age, and that it is much higher up than the areas they usually see wear and tear. They did a whole bunch of reflex testing and agreed with the last neuro - if I had no symptoms and no myelomalacia, they would just watch it, but I have many neurological symptoms (many I didn't even know were related) and combined with the myelomalacia she feels that I should have the surgery in the next few months. At this point, I kind of feel like I could get a third opinion, but the consensus is pretty likely to be the same - I am not a person they would want to do surgery on, but I they feel I need it =/

Got my third opinion today - second surgeon opinion - from an orthopedic spine surgeon. He wants to do a laminectomy with no fusion on C3,C4,C5 and C6. That seems like a whole lot of bone to lose. I asked him why not a laminoplasty and he said in his experience, people end up with a lot of arthritis pain from laminoplasty in the long run - I did a little research today and found a big study that showed that >3 level laminoplaties do seem to come with more long term pain than their laminectomy counterparts. I would worry about horseback riding with that much of my spine exposed I think though. He says he doesn't feel that I need fusion with my neck the way it is and that the laminectomy would be fine though. Anyone know much about laminectomy? The surgeon I saw today was wonderful - he said he was really happy that I was getting as much info as I could and said he was impressed with how much I had learned already. He also said he felt the other NS I has seen was an excellent surgeon and he could see why she chose what she did and that it was certainly a viable alternative - and that if it didn't work, I could still have the laminectomy later and that the acdf was less invasive - however he did say there would be a shorter time before I could be back to normal activities with the laminoplasty and it wouldn't effect my range of motion at all, which is certainly appealing.

I guess I am not curious to see what the third surgeon says. But with two surgeon's saying yes, I would be very skeptical if a third said no, I think. Both of the surgeon's I have seen have a reputation for not doing surgery unless it's absolutely necessary.