Results of MRI today...v. worried and need advice :(
 

Hi,

I have been in considerable pain for the past couple of weeks with left radiculopathy. My doctor sent me for an MRI and I got the results back today. I am Male, 37 and with a couple of young kids absolutely terrified about the prospect of surgery :(. Currently, the pain is severe through my left shoulder and left arm and I have had pins and needles in my left index and middle finger for the past week.

Any feedback really would be much appreciated, because I am really scared about this:

C2-3: Negative

C3-4: Negative

C4-5: Negative

C5-6: Posterior osteophyte disc complex is demonstrated. Mild central stenosis is noted. Severe bilateral foraminal narrowing is present, greater on the left.

C6-7: Spondylitic changes are present. Posterior osteophyte-disc complex is noted. A left paramedian disc protrustion is present.

C7:T1: Negative

IMPRESSION:

1. Spondylitic change at C5-6. Mild central stenosis is noted. Severe bilateral foraminal narrowing is present.

2. Posterior osteophyte disc complex at C6-7 with small left paramedian protrusion noted.


Thanks everyone. I am going with the assumption that surgery is going to be necessary, but is it as scary as I imagine it to be and might these problems be resolved with it?

Cheers :)

Hello and I am sorry you are in pain!

I can give you advice based on my personal experience with "severe bilateral foraminal stenosis" which will cause radicular pain in the shoulders and arms due to the pressure on the nerves passing through that space. I had it at C3/4 and C6/7 bilaterally and severe like yours. I consulted with 4 Neurosurgeons 3 wanted to fuse me at both levels but being that I am only 45 and spend my life mountaineering and skiing I wasn't comfortable with that after talking to many people and doing research on my own. What I learned was that if you fuse the levels below will deteriorate much more quickly and it will limit your range of motion permanently. So I went back to my physiatrist and got a name of a 4th NS who was highly rated and recommended by several other doctors. She was quite adamant that fusing now given my activity level, age etc., that I would be happier with what is called a 'foraminotomy and laminectomy'. This would not impair my ROM nor would it cause the lower levels to degenerate like with fusion. Basically they go in through the back side of the neck and drill the bone back open so that the nerves are no longer being compressed. It is a more invasive procedure and more painful (from what my doctor said) but is much better in the long run if it works. When I say 'if it works' .. She (my NS) explained to me that usually if it fails it is within the first year and then the only option is the fusion. I was ecstatic to say the least and went for it. Mine was 100% successful and I'm doing great 1 year and 4 months later. I didn't think the surgery was that bad but.. I had gone through 9 major surgeries just before that because my injury was caused by a head on collision where multiple body parts were affected so in comparison it was a piece of cake. All of my symptoms were immediately gone and the only regret I had was that in staging surgeries that this wasn't done sooner. In addition to arm symtoms I had headaches everyday and it was hard to turn my neck to the side.. haven't had a headache from neck pain since the day I went in to surgery - Praise God!!

My NS is in Seattle if you want her contact information please email me or PM me through this board. I learned that many doctors won't do this surgery as it seems they all want to fuse as fusion is easier for them but worse for us.. sad... so you might have to seek out several opinions if that is something you consider.

The good news based on your MRI is that you only have one level to deal with.. that is good!! Be good to your neck and to your body!! A physiatrist (a good one) is worth more than gold!!

Well, thanks guys for responding :) I have an appointment with the neurosurgeon on Thursday, so fingers crossed! Did either of you give steroid shots and PT a go? I am rather hoping that trying that will take care of the problem.

To be honest, I am petrified of surgery! Zookester, after reading your report I am certainly in two minds. The neuro surgeon I am going to see is apparently one of the best here in Lincoln, Nebraska and on the conservative site. I will ask him about the long term risks of fusion.

Dubious, you said that fusion surgery worked out ok for you? Can I ask how scary it is to go under for surgery and how long does it take afterwards for the pain to dissipate? I am hoping to not lose any time off work. I would at a desk (which is probably why I am in this mess to begin with!).

Admittedly, on my course of Hydrocodone, the pain is a little more manageable now, but I do still have the weakness in my left arm and the numbness in my middle and index finger in my left hand.

Cheers all :)

Yes, I highly recommend 'transforaminal injection' and at least it was my understanding that they actually do these injections for two reasons. One to help you get relief from the pain but most importantly to determine if surgery would likely be a success. What I mean by that is if they inject the steroid at the foraminal opening at the damaged level and you get relief then it confirms that is what is causing your symptoms and that surgery is likely to be successful. I also highly recommend massage therapy and PT/Chiro (as long as the Chiro has all chartnotes and MRI/Xray reports) because the muscles along your neck and shoulder will invariably be tightened and need to be released or relaxed so that this isn't worsening your symptoms. This is especially true if you sit at a desk like you mentioned. I would also recommend checking the ergonomics of your desk, keyboard and monitor height and using a proper headset if you are on the phone often. Sometimes just adjusting the monitor height can do wonders for relieving pain in the neck and numbness in the arms or at the very least keep the pain symptoms from returning after you finally get relief. All to often people seek help of PT/Chiro/Massage etc., and get relief and then spend hours on the couch watcing TV with poor posture or return to work and do the same only to undue what was just done and then wonder why they aren't improving. I ended up getting a sit/stand desk for work and changed my TV and sitting arrangement in our home to prevent as best I could any additional strain I was inadvertently placing on my neck.

If you do go to PT be sure to be diligent about doing the home routine if they give you one.. it takes commitment but, is well worth it if you can get away from the pain instead of living with lifelong neck/back problems. Which is all to common.

I also recommend what is called a "tiger tail" which you can get from amazon or REI they make it really easy to relax tight muscles throughout the body.

Lastly.. yes it is always better not to undergo surgery but, once the nerves are causing symptoms and the opening are closed enough to cause the radiologist to comment that it is "severe foraminal stenosis" then most likely the least aggressive surgical fix is warranted. When I say least aggressive that is the foraminotomy not fusion. The surgery for the foraminotomy is more invasive but, less aggressive if that makes sense.

Here is a link to more information about a foraminotomy and the amazing surgeon that performed my surgery. http://seattleneuro.com/patient-educ...-foraminotomy/

I hope that helps,
Tessa

Thanks guys :) I have the appointment with the neuro surgeon tomorrow and will certainly ask about PT. I would do whatever they ask if it meant alleviating this pain! Admittedly, with the hydrocodone, the pain is manageable.

Quick question, did either of you try a chiro? I tried one immediately after I had initial pain and unfortunately it made things much worse. I am tempted to try it again though. Isn't it supposed to get worse before it improves?

Cheers :)

Oh yes, I saw my trusted Chiro along with a massage therapist 2-3 times per week prior to giving in to the idea of surgery. But.. they need to have your complete imaging file, chart notes available prior to touching you. And then only very gentle traction or use of what I call the "clicker" (not the technical name). And they should provide you with massage to that area and moist heat prior to any adjustments including traction because the muscles are likely tightened and pulling on your neck/head. KT taping can also be helpful and many good Chiro's can apply it properly.

Moist heat and epsom salt baths are also really good for relaxing the strained neck muscles and can lessen pain levels.

Good luck, eat healthy and stay positive!
Tessa

Zookester, I actually stopped seeing my chiropractor b/c I feel like he made things worse. To be honest, I'm not quite sure how I have ended up in this state at 37, I am just really fearful and scared about what to do next. I have the appointment with the neuro surgeon tomorrow and just filling out the paperwork makes me nervous. I have insurance etc through work, but I was born and raised in the UK and seeing so many questions about finances and stuff about certain things not being covered by insurance just makes me nervous. I am used to the NHS where it takes 6 months for anything to get done, but at least you know it is paid for :)

Although, I have been in the US for 14 years now..just nothing more serious than an appendectomy in that time :)

Anyways...my chiropractor saw my MRI results and said to me that he still thinks that he can fix things. My posture is pretty awful and he said with adjustments etc, he can free up the nerve.

A lady at work told me she had the same injury and was able to fix it through steroid injections and PT.

I'm not sure who to believe at this point, b/c I feel like the neuro surgeon will probably want to just do the fusion surgery thing, but then doesn't that leave me open to all sorts of problems down the road? A couple of people have told me that fusion surgery on c6 and c7 means the other discs will have issues later on?

Sorry for blabbering so much, but a few weeks ago I couldn't have even imagined being in a situation like this and suddenly it feels like I am falling apart.

Cheers guys.

Any Chiro that says they can "fix" you is not one I would go and see. They can "help" alleviate pain and adjustments can help with realignment and which assists in postural imbalance that will only further cause pain but they cannot "fix" degenerative changes in the spine, ruptured discs, nerve compression from bone spurs. Consider a chiropractor like a toothbrush is for your teeth they assist you in preventing decay. A good Chiro will tell you this and work with you to improve the function of your spine. Sorry to ramble.

Injections, PT, Chiro and lifestyle changes are the first line of defense in alleviating pain and avoiding surgery. Unfortunately once the nerve pain travels down the arm those nerves are essentially setting of an alarm to warm you that something is really wrong and if left that way it can become permanent or worse both in pain and function. When the formainal opening is closed enough for the MRI report to note "severe" that means it is unlikely that much will help long term. Sure, an injection will help and might even give you an extra 6 months to a year but because it is bone that is closing off that hole until that is corrected through surgery, things will not improve for the long term. Personally I would not get a fusion at your age. I would seriously consider, and highly recommend, the foraminotomy which will NOT stress or cause deterioration to your lower levels like with the fusion.

Just my opinion. I would also highly recommend seeing more than one Neurosurgeon for an opinion.

I do wish you the best,
Tessa

Thanks both of you :) Just got back from seeing the neuro surgeon and he he said that he does recommend surgery. He said fusion is an option, but at my age he wasn't too keen on the idea since he might end up having to fuse in two places. The surgery that he did recommend was disectonmy (sp?) in which he goes in and removes part of the disc which is causing the problem. Tessa, I did mention foraminotomy and he said that is actually part of the procedure.

Does that make sense?

Cheers :)

Hello kissiffer
 

Make sure you go for another opinion. When ever your MRI says severe, and there is cord impingement, the doctors do take that second look to see if you can be helped surgically. Please try all known therapies before you choose to do surgery. The surgery can be of benefit. In my non medical opinion, both the vertebra that show damage should be addressed at one time
Sometimes when hardware is used, the weakened vertebra above and below the site are at risk. This is something to watch out for and ask your doctor about. I had C6-7 done, and actually didn't know the ones above were also damaged. I didn't ask or get that second opinion. I wound up 5 years later fused C3-7, called the domino effect. My last surgery did work.
Let me know if you can how it goes for you. I also understand about being afraid. It is traumatic to go through the surgery. NT will support you in any decision you make. I came here for the same reason. Those that had the fusions before me, helped to ease my way through the process. I wish you all the best. ginnie:grouphug:

Thanks Ginnie :) He did mention that he wanted to do a partial discectomy. He suggested that was a bit different than the fusion since b/c of my age he didn't want to go down the fusion route. Does that sound right?

Thanks!

Yes, that does make sense and that was also part of my surgery. The nerve pain however down your arms is coming from that opening and that (the foraminotomy) will alleviate much of your pain.

Though I respect Ginnies opinion a great deal, I disagree with the statement taht if the MRI report says "severe" there is cord impingement. In this particular usage (on your MRI) they are specifically speaking to the opening of the foramin where the nerves come thru and it is "severe" in that the nerves are being compressed due to the severity of that opening being blocked off by either bone or disc material. Foraminal stenosis is the closing off of that opening vs. 'spinal stenosis' which is the reduced area or compression in the spinal canal - two completely different areas of anatomy. I do of course agree with another opinion although it sounds like this NS is a good one since he isn't recommending fusion like so many do. Good for you! It is my humble opinion based on my own experience and discussion with many doctors that at that degree of compromise that surgery and a lifetime of continued therapy and preventative protection and conditioning that it is your only chance of recovery long term. Eat well, stay hydrated, exercise daily and stay positive :)

Best wishes,
Tessa

Thanks Tessa :) I think I have pretty much made up my mind to do the partial discectomy surgery. Honestly, a couple of weeks back I didn't think it would come to this, but the NS has some good recommendations from a PT that we know (that's good right, since the PT probably works with some of his patients following surgery!). Mentally it is tough, but fixating on things is probably not helping me and maybe I need to think more along the lines of this actually being something that will help it get better :)

One question I forgot to ask him is about the weakness in the left arm. I had little to none resistance against one exercise he did with my bicep. Is that because of the nerve impingement or is it because my arm is weaker since I haven't been using it at all? I wonder if that might get better by itself in time?

Thanks.

Hi guys,

One other thing..I read about a procedure Peyton Manning had:

http://www.dailypress.com/news/crime...1813523.column

It says he had a "anterior cervical discectomy and fusion". Now, one thing it also says is he had a:

"bone graft goes in the disc space and a small plate acts as a cast to let it heal."

"Essentially the two bones that are treated, the disc between those two bones will be connected with a bone bridge as the fusion progresses over three months or so."

The NS I saw this morning didn't mention anything about a bone graft. I had the impression once the problematic disc is removed it is just left like that?

Any advice? I was starting to feel ok about the surgery and now I read this I am starting to worry again that mine will be missing something.

Thanks :)

Hi Kissiffer
 

Hi, Just get that second opinion to confirm the DX and proposed surgery. This is just to give you peace of mind that the procedure is right for you. Ask all the questions you can of your surgeon. Things will turn out OK. ginnie

Ooops big mistake. In reading Ginnie's response from earlier- I misread!! I apologize. Ginnie, I am sorry!! She is right in pointing out that you also had Mild Central Stenosis but since no cord impingement is noted along with that, it is mentioned mostly for baseline information and not something they will likely address especially without actual noting of cord involvement. Again Ginnie I am sorry I didn't take more time to read properly.

She is also right about getting another opinion - personally I would not have surgery (especially on the spine) without at least 3 concurring opinions and treatment recommendations.

Thanks guys. Let me see if I can get a second opinion. To be honest, after meeting the surgeon today I felt like his approach was probably the only realistic one, since the weakening of the arm is a pretty bad sign. I will try to speak with somebody else in the next week if I can though.

When I do see somebody else, should I tell them what this NS said or just let them make up their own mind?

Thanks!

Surgery scheduled!
 

A little update..I have surgery booked for Feb 5th :) I did ask the NS's nurse about C5-C6 "Severe bilateral foraminal narrowing is present, greater on the left" and she said he only found that there was a problem at C6-C7, which is where he will be doing a posterior microdiscectomy. He found the problem with C7 during the exam when he tested my triceps strength in my left arm and I had zero resistance.

So...I am pretty tense and nervous at the moment, but glad all the same that I have a date for surgery :)

Hi kissiffer4
 

I hope you get a second opinion. I wouldn't tell the new doctor what was found, but rather I would listen to him and his opinion. Good to have a match in what the doctors think would be the best protocol.
I had C6-7 done. I didn't know there was another vertebra above that was damaged. I also didn't think I needed another opinion. It is from my own experience that I say that second opinion is important. If another of your vertebra says "serious " in the language, that is the reason for the second doc. You want the spine above and below to be stable enough for the procedure. I know what ever you choose will be right. There can be very good outcomes for the surgery. Take it easy when you get home for awhile. ginnie:hug::grouphug:

Thanks ginnie. You know, I think I am driving myself nuts. I have gone a whole day today without any pain meds and for the first time since I injured myself, I feel pretty good. I still have some pain in my left shoulder and down my arm, but overall the pain isn't too bad. My only question is about the weakness in my left tricep. That is still there and the NS did say that I would need surgery. What to do :(

Progressive neurological deficit (reflex change, atrophy, weakness) is a strong indicator for decompression :(

I too personally would get a second opinion and even a third before undergoing this surgery. Also, I would ask if only C7 is the problem and that is all that is being worked on during surgery will the C 5/6 nerve openings just fix themselves?

Spine surgery in my opinion is not a surgery that anyone should go into without consulting at minimum one other surgeon and two others if the opinions and recommendations don't match. I second what Ginnie recommended as far as not sharing the previous doctors notes and getting a unbiased fresh opinion.

There is just to much risk.. here is a very sad and enlightening story about what by all appearances and credentials this Neurosurgeon seemed excellent.. sadly that wasn't the case and many suffered at under his hands, including a childhood friend who was left paralyzed after what should have been a simple day cervical spinal surgery. http://www.texasobserver.org/anatomy-tragedy/

I'm not sharing this to scare you just to caution you that in pain we all want things done quickly but sometimes it is better to be patient and confident before committing.

Either way you go.. best of luck to you - wishing you a speedy recovery!!

Hi kiss.....
 

I know how nuts you feel. I went through a lot of those same emotions. so did most of the folks responding to you. surgery is always a last resort. Try all therapies kind of thing before you do it. That second opinion would take all the stress out of it. You would know beyond a doubt that the decision to do the surgery is right for you. It is a very hard decision to make, and not one any of us took lightly either. We will all be here for you in any choice you make. I didn't ask you before, but do you have a good support team? That also helps when you have to face this kind of problem. I do wish you all the best. ginnie

Thanks guys. I have an appointment with a different neuro surgeon on Friday, so will see what he has to say. Am I potentially rushing the surgery by booking it for Feb 5th? I wonder if I ought to go and see a neurologist or pain management doctor before I go into surgery?

One neurgologist who a friend of mine works with looked at the MRI report and said that I ought to wait 6 months to see if it will clear up on it's own because of my age. I am 37, not terribly young by all means, but he seemed to think there was a chance it could clear up by itself. When I take ibuprofen the pain isn't anywhere near as bad.

Anyway...I am also seeing the original neurosurgeon on Monday (before the surgery on Wednesday), so I will see what he has to say then :)

Thanks all!

Hi Kissiffer
 

Glad you have another appointment. This is so important. Also seeing a neurologist is a good idea. Any time you have this kind of thing to face, that other opinion or two can only help.
Have your tried PT or any injections? Pain management would be the route to go if you held off on surgery. Only you can decide if the Feb. date is good. See what the doctor says next Friday. Bring someone with you to the appt. doctors tend to address the issue a bit more serious when you have someone in the room with you. Also they may pick up information you may miss. If both doctors have extremely different views, then perhaps look into another neurologist. It is OK to weigh all the information before you do this surgery. ginnie:grouphug: