[canwin67]

Hi, my name is Candace. I've had neck problems for over 20 years because of a car wreck that gave me a severe case of whiplash.
Last year I was rear-ended again which reinjured my neck. I suffered for months in pain before I finally broke down and went to the ER thinking they would give me steroids and pain meds and send me on my way. The pain seared from my neck and down my left arm making it feel like it was on fire and my pinky and ring finger were completely numb. I was in complete agony. They sent me for ex-rays, a CT scan and an MRI. To my surprise, the MRI showed multiple levels of damage and it was decided that I would have a posterior laminectomy at C7-T1. The surgery went well and when I awoke, I was thrilled to find the searing pain gone although my fingers were still numb and my hand was still weak.
At the time I did not have insurance, so I didn't do any physical therapy and only had one post-op visit with the neurologist and that was to remove the staples. I recovered pretty well and soon went back to work but the numbness and weakness persisted and my neck remained achy.
A week ago I was carrying a load of laundry, didn't see one of my daughter's toys on the floor and I tripped landing with the brunt of the impact on my chin which caused me to hyperextend my neck. The pain was instantaneous and massive. This time I was only able to stand it a day or two before I was back in the ER, begging for some kind of relief and terrified that I had somehow "broken" the surgery.
They ran the same tests again (ex-rays, CT scan, and MRI with and without contrast) and immediately checked me into the hospital. The attending physician said I have the c-spine of an 80 yr old woman (I'm 45) and immediately got neurology involved. It ended up being the same neuro as before and this time he wants to do an anterior fusion of three levels that would include donor marrow and hardware. The neurologist was getting ready to go on a three week vacation so since I have insurance now, he set me up with a pain management doc, a Miami J collar that I'm to wear at all times and an appointment to see him when he gets back into town.After I got out of the hospital, I went to the pain management doc who suggested three left transforaminal epidural steroid injections at c4-5, c5-6, and c6-7 at 5k a pop. The injections gave me a very small amount of pain relief and for now he is managing my pain with percoset, zanaflex and lyrics. Of course he wants to do another round of injections, this time going in at the back of my neck. The neck pain and the shooting pain down both of my arms is so bad that I'm willing to try anything...especially since the neuro won't be back for a couple of weeks.
Since I didn't have insurance the last time around, I got very minimal care and really knew next to nothing about my test results and the extent of my injuries.
Thankfully this time, I've got insurance and was able to get the MRI results and copies of all the doctors reports which I have to be honest...they sound pretty terrifying.
If you don't mind, I am going to share the MRI report in the hopes that I can get a little advice and maybe some piece of mind. Here goes, OK?
The c1-2 relationship is within normal limits.
At c2-3, mild disc space narrowing is noted with broad-based posterior disc osteophyte complex greater to the left than to the right. This produces moderate encroachment of the left c2-3 foramen. No pathological enhancement.
At c3-4, there is broad-bases annular bulge with disc osteophyte complex formation bilaterally resulting in moderate to severe bilateral foraminal stenosis without evidence of herniation. No evidence of pathological enhancement.At c4-5, the disc space is relatively well preserved but there is moderate left posterolateral disc osteophyte complex formation producing moderate to severe left foraminal stenosis at c4-5. No evidence of acute herniation. The left side of the spinal cord appears to be flattened at this level though the CSF space can still be seen anterior to the cord.
At c5-6 there is marked disc space narrowing and anterior osteophyte formation as well as endplate degenerative changes. Broad-based disc osteophyte complex formation is present slightly greater to the right than to the left. The right foraminal stenosis is severe and the left foraminal stenosis is moderate to severe. There is indentation of the spinal cord secondary to central disc osteophyte complex. The cervical cord appears slightly flattened.
At c6-7, the disc space is moderately narrowed with moderate broad-based disc osteophyte complex formation producing cord flattening and bilateral foraminal stenosis. No evidence of pathological enhancement.
At c7-t1, there is focal left posterolateral annular bulge and high signal in the posterior annulus raising the possibility of acute annular tear. The focal disc protrusion produces left c7-t1 foraminal stenosis and some displacement of the cervical cord to the right of midline. No evidence of pathological enhancement.
The t1-2 level is unremarkable.
There do appear to be postoperative changes in the left posterior spinal soft tissues. The lamina and spinous processes remain intact.
Impression:
1. Severe multilevel cervical degenerative disc disease with a very similar pattern compared to July 2012.
2. There are areas of cervical cord flattening at c5-6 and c6-7.
3. Multilevel foraminal stenosis with specific levels described above.
4. Left posterolateral disc profusion at c7-t1 with possible acute annual tear.
5. No marrow abnormality detected except for the endplate degenerative changes at c5-6.
So that's the whole report. What concerns me the most is impression #1. If it's a very similar pattern to my last MRI, it makes me wonder why the neuro didnt perform the fusion last year that he wants to do now. It worries me and makes me think I should find a different neurologist. The other scary part if this MRI is the evidence of the spinal cord flattening. what does that even mean? I'm terrified that I'm going to move the wrong way and end up paralyzed.
I'm sorry if I'm being a drama queen but I am very frightened. I'm divorced and take care of my aging and ailing mother. If something were to happen to me, I don't know how we would make it.
If you made it this far, thank you so very much for reading. I apologize that my very first post is so long. If you have any advice or words of encouragement, I would greatly appreciate hearing from you.
Thanks again,
Candace

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[ginnie]

Welcome to Neuro Talk. Sorry for what brought you here, but you will find support and a few friends too. Leesa is the best for reading the MRI.
Before you do another round of steroid injections, make sure that is what you really want. If they don't work the first time, they are most likely not going to work a second time. In your situation, maybe get another opinion, with someone other than the one who did your surgery last time. This is the one thing that I did not do, get another opinion, and I wished I had.
I reversed the curve of my spine, and am fused C3-7. There are issues, called the dominio effect. You need to ask your physician (all of them) the risk to the verterbre above and below the proposed surgical site. Sometimes due to the lack of strength in damaged verterbre, the hardware, and such do not hold up, and this leads to more and more surgery. I don't want to frighten, but inform you that doctors do not on a regular basis address this most important issue. Also those shots cost the insurance company a huge amount of money. there are other injections to try, that may have more benefit to you. I had Ketamine infusions, which did help until I got to surgery. Steriod injections didn'd do sqat for me either. I will be here to listen any time. More of us with back issues will answer you. When I came to NT, I was a mess, and it was leesa who read my MRI and help to inform me of what I was really facing. She is excelent in this regard. I will keep you in my thoughts and prayers. ginnie

[Leesa]

Maybe I can help a little:

C2-3 Disc space narrowing with broad based disc spur producing moderate encroachment of left C2-3 foramen. The foramen are the holes that the nerves pass thru to get to the spinal cord -- yours are narrowing due to the disc spurs.

C3-4 Broad based annular bulge with disc bone spurs bilaterally resulting in moderate to SEVERE bilateral foraminal stenosis (see above) without herniation.

C4-5 Moderate left posterolateral bone spur formation producing moderate to SEVERE left foraminal stenosis (see above) . The left side of spinal cord appears flattened.

C5-6 Disc space is moderately narrowed and anterior bone spur formation as well as endplate degenerative changes. The endplates are the axon of a motor neuron that contacts with a muscle fiber; A broad based bone spur formation is present slightly greater to the right than the left. The right foraminal stenosis is SEVERE, the left foraminal stenosis is moderate to severe; There is indentation in the spinal cord secondary to central disc bone spur complex. The cervical cord appears slightly flattened.

C6-7 Disc space is moderately narrowed with moderate broad based disc spur complex producing cord flattening and bilateral foraminal stenosis.

C7-T1 posterolateral annular bulge and high signal in the annulus meaning the possibility of an annular tear. The Annula is a fluid filled sac that the disc sits in and it also contains nerves. If the annula tears, and the fluid spills out on OTHER nerves, it is very painful. The focal disc protrusion foraminal stenosis & displacement of the cord.

On the impression, he writes "severe degenerative disc disease." This is drying out of the disc, which everyone gets. This comes with age, and some people get it worse than others. When the discs dry out, they flatten which makes them bulge and/or herniate -- then they push on nerves and that's PAINFUL!

The flattening of the cord isn't something to sneeze at, although he doesn't say it's being compromised or compressed, etc., and there's no evidence of myelomalacia so that's good.

I do think I would take these films and get 2 MORE OPINIONS from NEUROSURGEONS. Don't ever take just one opinion!!! You must have 3 opinions from Neurosurgeons before EVER undergoing the knife!!! Surgery should be your last option after exhausting every conservative option. And you must remember that surgery is only for mechanical problems. It isn't for pain. Most often you're left with the same pain or worse after surgery.

Please let us know what happens, okay? We ALL really want to know, okay? And if you have any more questions, or if I totally confused you about this MRI, let me know. LOL Big hugs, Lee

[sfink]

Hi! You two girls are giving out some really good advice here. I'm going to study this and throw in my 2 cents when I have something helpful to offer. Just want to underline - the surgery is all about the mechanics ,pain control is secondary to the surgeon. Cruel but true,he thinks if he can get the mechanics correct, the pain problems will be diminished. I'll be back later, sfink

[Leesa]

Just PLEASE get other opinion, will you? The flattening of the cord is what scares me, and i would NOT want to take just ONE doctors opinion on this. If he's just going to "pooh pooh" the pain element, what ELSE is he going to "pooh pooh?" Granted, usually pain is NOT eased after surgery but it IS an important factor that the surgeon MUST take seriously. He can't just ASSUME that the pain will just be diminished by the surgery. He'd better have a PLAN in effect for the pain!!! Grrr, this makes me mad!

These doctors can really make me want to go BACK to drinking sometimes and I've been sober almost 20 years! SHEEESH

Please get more opinions, okay? God bless!

[ginnie]

I agree with Leesa, get another opinion. This doctor isn't giving you all the information he should. You do have some issues to take into consideration. No surgery until you get those other opinions. Maybe your PCP can give you another referral. I wish you all the best. ginnie

[sfink]

Hi! I'm back again. That "seering" neck pain,pain down your arm and finger numbness makes me think u have a spinal cord compression going on here. You have described the progression of nerve damage, it goes something like this-neck burning to arm tingling,arm to hand tingling-numbness-burning. Next,that get's more intense, and then your feet become numb. Next, you can't feel your feet at all, and you become numb from the waist down. Next, urinary and bowel incontinence starts. Now, if something isn't changed through surgery,paralysis begins. Can"t walk, your motor skills with arms and hands are deficient- you basically can't do anything. Your in a tough spot, get another opinion; but try not to ride it out too long.. The dirty little secret that no one tells you- Severed nerves NEVER grow back: that 1cm a month statement rarely happens in the real world. Don't panic, but push forward to get some straight answers. By the way, that girl who read the mri interpreted it correctly- good job... later,sfink