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-   -   MRI help, please? (https://www.neurotalk.org/spinal-disorders-and-back-pain/181321-mri-help-please.html)

Holles 12-20-2012 02:31 PM

MRI help, please?
 
NEW MRI 9/12
C1-2 level is anatomically aligned. C2-C3 normal.
C3-4 normal disc, markedly severe degen hypertrophy of left facet joint with bony hypertrophy. This flattens the left lateral margin of the cord displacing it slightly to the right and causes severe left sided foraminal stenosis. ? sequela of old healed bony trauma.
C4-C5 normal disc, mod degen hypertrophy of right facet joint. mod right sided foraminal stenosis.
C5-6 disc is slightly narrowed. Small broad osteophytic ridge mildly effacing thecal sac but not compressing cord.
C6-7 disc slightly narrowed.
C7-T1 normal.

There is, according to the Dr., plenty of space in the canal, but wouldn't displacing the cord cause some complications? No one seems to have an explanation for the pain.

Leesa 12-21-2012 05:46 PM

I'll try to help a little ~

C1-2 It's fine

C3-4 The disc is ok; you have severe bony overgrowth of the left facet joint. The facets are those "wing-like" structures on each side of the spinal cord. If you hunch over alot, you can even feel them. The bony overgrowth flattens the left lateral margin of the cord pushing it to the right and causes severe left sided foraminal stenosis. The foramen is the hole that the nerves pass thru to get to the spinal cord. Stenosis is narrowing.

C4-5 The disc is normal; moderate degenerative overgrowth of right facet joint (see above) and moderate right sided foraminal stenosis (see above)

C5-6 Disc is slightly narrowed; Broad bone spur ridge mildly effacing (wiping out) the thecal sac but not compressing cord. The thecal sac is a membrane of dura matter that surrounds the spinal cord and cauda equina. The thecal sac is filled with cerebral spinal fluid.

C6-7 The disc is slightly narrowed.

C7-T1 Normal


First let me say that, I'M NO DOCTOR. But it seems to me that C3-4 would certainly be part of the problem! When the bony overgrowth is pushing on the spinal cord and displacing it, causing SEVERE foraminal stenosis, that is GOING TO HURT! Why?? Because nerves go thru the foramen, and when that hole is made smaller, it makes it difficult for the nerves to pass thru, and they become impinged! Plus something pushing on the spinal cord isn't any picnic! :eek:

I would definitely have a NEUROSURGEON take a look at this, if you haven't already. If you have, then take it to another one! You do need another opinion.

Please let us know what happens, will you? I wish you the very best. God bless and please take care. Hugs, Lee ;)

gatorhead 12-22-2012 09:59 PM

Well explained on the MRI readings! The only things I have to add are that I agree with her also about the Severe foraminal stenosis being a cause of pain. The facet joint hypertrophy is another cause of pain. From my understanding when they word it as they have then there is instability at that point, so if there is when it moves it is likely pinching that nerve further and could also be pushing the cord further as well.

The major thing to take into consideration on an MRI is the results are often better than reality because the spine is not loaded, meaning it isn't bearing any weight which would make the bulges bigger, the holes smaller etc.:winky:

Holles 01-04-2013 02:07 PM

Thank you so much!! I'm so tired of the Dr.'s saying nothing could be wrong. Including a spine specialist. They said there is plenty of space for the cord but honestly, isn't the fact that the cord is flattened enough cause for action?

This is the MRI from 2009:

mild arthritic changes C1.
C2-C3 no stenosis
C3-4 left facet joint severely hypertrophic, associated endplate osteophytic ridge with mild to mod left foraminal stenosis. No central canal stenosis. Osteophytic ridge extends into left lateral recess (left lateral recess stenosis). Overall exuberant calcification suggestive of previous fracture of lamina or facet joint w/ calcification & degenerative changes.
C4-5 mild degen changes rt facet joint, element of endplate osteophytic ridge.
C5-6 small central disc protrusion w/ assoc annular tear. mild facet degenerative changes, no stenosis.
C6-7 small broad based posterior disc osteophyte complex. Assoc annular tears.
C7-T1 normal disc space.

Summary: Degen changes of left C3-4 facet joint. Assoc calcification & thickening of adjacent left lamina. Mild degen disc bulge at C6-7, mild central disc protrusion w/ assoc annular tear C5-6.

So the annular tears appear to have healed in those 3 years, but at the expense of narrowed discs. This MRI was seen by a neurosurgeon, who felt I had no cause for pain.

I don't know what else to do. The physiatrist is the only Dr. who was willing to listen to me. And now he wants another EMG. Erg. So frustrating!

gatorhead 01-05-2013 12:04 AM

Quote:

Originally Posted by Holles (Post 944505)
Thank you so much!! I'm so tired of the Dr.'s saying nothing could be wrong. Including a spine specialist. They said there is plenty of space for the cord but honestly, isn't the fact that the cord is flattened enough cause for action?

This is the MRI from 2009:

mild arthritic changes C1.
C2-C3 no stenosis
C3-4 left facet joint severely hypertrophic, associated endplate osteophytic ridge with mild to mod left foraminal stenosis. No central canal stenosis. Osteophytic ridge extends into left lateral recess (left lateral recess stenosis). Overall exuberant calcification suggestive of previous fracture of lamina or facet joint w/ calcification & degenerative changes.
C4-5 mild degen changes rt facet joint, element of endplate osteophytic ridge.
C5-6 small central disc protrusion w/ assoc annular tear. mild facet degenerative changes, no stenosis.
C6-7 small broad based posterior disc osteophyte complex. Assoc annular tears.
C7-T1 normal disc space.

Summary: Degen changes of left C3-4 facet joint. Assoc calcification & thickening of adjacent left lamina. Mild degen disc bulge at C6-7, mild central disc protrusion w/ assoc annular tear C5-6.

So the annular tears appear to have healed in those 3 years, but at the expense of narrowed discs. This MRI was seen by a neurosurgeon, who felt I had no cause for pain.

I don't know what else to do. The physiatrist is the only Dr. who was willing to listen to me. And now he wants another EMG. Erg. So frustrating!

The c3-4 has gotten worse from the previous study to the last. It states there is SEVERE Stenosis of the left foraminen so that nerve root is being pinched and causing pain down the back of the neck into the shoulders and down into the arm???? It can cause havoc and be severely painful. I would see another neurosurgeon or an ortho......

Dubious 01-05-2013 11:56 PM

Quote:

Originally Posted by gatorhead (Post 944645)
The c3-4 has gotten worse from the previous study to the last. It states there is SEVERE Stenosis of the left foraminen so that nerve root is being pinched and causing pain down the back of the neck into the shoulders and down into the arm???? It can cause havoc and be severely painful. I would see another neurosurgeon or an ortho......

Either a neurosurgeon or an ortho; maybe both for opposing opinions....so long as they are both spine fellowship trained!

Holles 01-09-2013 09:19 PM

Thank you!

Today I had another EMG, which was normal, as I expected. The new weakness in my right arm is not due to any rotator cuff problems (could have told them that, too). So two more useless medical tests.

Dubious 01-09-2013 09:59 PM

Quote:

Originally Posted by Holles (Post 946144)
Thank you!

Today I had another EMG, which was normal, as I expected. The new weakness in my right arm is not due to any rotator cuff problems (could have told them that, too). So two more useless medical tests.

I wouldn't go so far as to say the tests were useless. There is so much of your story that is not conveyed here that it is almost impossibly difficult to "speculate" what might be happening. Your docs whom have had the benefit of taking a history of your complaints, listing out your subjective complaints, i.e. location, timing and intensity or demeanor of pain, provocative and palliative influences (etc. ad nauseum) and your examination findings and then being able to corrollate all considerations with your imaging and neurodiagnostic findings have a distinct advantage over anyone here!

EMG's in of themselves are problematic in that sensitivity runs at about 60-70%. They can produce a false normal in 30-40% of the subjects so that a normal EMG may mean that you either are normal or the study missed the mark even in the presence of abnormality. It is a good study to do but is fraught with error and one must order the approriate levels of which to perform the test in consideration of a suspected diagnosis. If weakness of your arm is a concern (first I've seen in your posts), additional tests might be prudent like NCV or SSEP. They may be normal as well. All of these tests, both normal and abnormal, have unique and individual meaning for you. So in the bigger picture, in the event of many normal or negative studies, learning what it is not can be just as instructive in figuring out eventually what it "is."

And the problem with just reading an MRI report without the benefit of seeing all 25-30 images of the MRI and being blinded as to any examination findings, is most unhelpful! It would sort of be like trying to decide if you like a particular car by only reading the owners manual and never seeing it, test driving it or even sitting in it! I know it's frustrating, but keep working with and pressing your docs!

Holles 01-11-2013 11:16 PM

Excellent points, Dubious!

I'll post an "introduction" story.

I so appreciate your help!

Holles 05-01-2014 06:10 PM

Resurrecting old thread
 
Hi everyone! No improvement, although the physiatrist was helpful. So far acupuncture is the only relief and that's just to stop muscle spasms in my back.

There are many conflicting opinions about surgery on here but I'm curious ( and getting desperate). I'm not wild about having my spine fused, and understand it won't take away all the pain, but wouldn't it stop bones from shifting around and pressing on nerves?

We went to HuHot for lunch yesterday and I was spilling ladles of stuff all over - my arms are unstable reaching forward and out. Heck of a way to spend the next 30 years.


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