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Hi. I'm waiting to see a neurosurgeon and wanted some help understanding my MRI report. Any help would be appreciated.

These are the findings:

March 18, 2009 MRI of cervical spine
Routine cervical spine MRI was performed on a 3.0 Tesla unit.

Findings:
Anatomic alignment. Ventral body heights are well preserved. No evidence for cord expansion, syrinx, or cerebellar ectopia. Craniocervical and cervicothoracic junctions are intact.
C2-3, C3-4, C4-5: Mild degenerative disc disease. Mild broad based posterior disc bulge. No significant neural foraminal or central canal stenosis
C5-6: Circumferential disc bulge and super imposed moderate focal central disc protrusion / herniation severely narrows the central canal to 7mm with flattening of the cervical cord. Uncovertebral spur and disc bulge cause moderate bilateral neural foraminal narrowing.
C6-7: Moderate broad based disc bulge mildly effaces the central cervical cord.
C7-T1: Unremarkable

CONCLUSIONS:
1: at C5-6, circumferential disc bulge and super imposed moderate focal central disc protrusion/herniation severely narrows the central canal to 7mm with flattening of the cervical cord. Uncovertebral spur and disc bulge cause moderate bilateral neural foraminal narrowing.
2: Moderate broad based disc bulge at C6-7 mildly effaces the ventral cervical cord.
3: Multilevel disc degenerative disease detailed above.

Thanks!!
Your big problem is at C5-6 where your spinal cord is compressed to 7mm. Anything under 10mm is abnormal and will eventually need surgery to remove the disk and restore the cord to normal size.

Cord compression causes numbness and loss of function anywhere the cord is feeling the compression. The pressure is transferred inward so it may not show up in the C5-6 nerve area but anywhere below that level so it may show up in your legs or feet or even toes. I had cord compression to 6mm at the same area and the disk above and below it. My toes were numb, I had trouble moving my legs forward and eventually, trouble with my hands dropping stuff all the time. I had very little pain, mostly slowly progressive numbness and loss of function.

Chances are the neurosurgeon is going to propose surgery to relieve the cord compression there and the early stage compression in the disk below. There are surgeries from the front of the neck and the back and lots of new options including surgeries that don't involve fusion. Ask your surgeon for ALL the options and which he feels is best and decide which you feel the most comfortable with. Then come up with a compromise.

Spine surgery today is pretty good if you have a good surgeon. There is no board certification for spine surgeons so you have to ask lots of questions....like how often he works on spines. Some neurosurgeons work on brains and spines, some do only spines...ask. The more experience they have with spines the better the surgery will go.

Good luck and come back with any questions you have.

JennyB(fused C3 to T1 and going back for more next month)
[QUOTE=jennybyc;3975361]Your big problem is at C5-6 where your spinal cord is compressed to 7mm. Anything under 10mm is abnormal and will eventually need surgery to remove the disk and restore the cord to normal size.

Cord compression causes numbness and loss of function anywhere the cord is feeling the compression. The pressure is transferred inward so it may not show up in the C5-6 nerve area but anywhere below that level so it may show up in your legs or feet or even toes. I had cord compression to 6mm at the same area and the disk above and below it. My toes were numb, I had trouble moving my legs forward and eventually, trouble with my hands dropping stuff all the time. I had very little pain, mostly slowly progressive numbness and loss of function.

Chances are the neurosurgeon is going to propose surgery to relieve the cord compression there and the early stage compression in the disk below. There are surgeries from the front of the neck and the back and lots of new options including surgeries that don't involve fusion. Ask your surgeon for ALL the options and which he feels is best and decide which you feel the most comfortable with. Then come up with a compromise.

Spine surgery today is pretty good if you have a good surgeon. There is no board certification for spine surgeons so you have to ask lots of questions....like how often he works on spines. Some neurosurgeons work on brains and spines, some do only spines...ask. The more experience they have with spines the better the surgery will go.

Good luck and come back with any questions you have.

JennyB(fused C3 to T1 and going back for more next month)[/QUOTE]
Thanks so much. From the reading I've done I thought surgery would probably be necessary for the C5-6 area. I was hoping I'd only need the one level done.

The neurosurgeon that I'm seeing is supposed to be one of the best in the area and involved in some of the research and development of spinal procedures and even appliances. So I feel pretty good about his capabilities but still wonder if I should get a 2nd opinion. I have an appt May 20th with him (it took 2 months to get in!!)

Also, I'm wondering if there is any danger of paralysis with the spinal cord flattened to 7mm and if there are things I should avoid. I love to horseback ride but have really curtailed it. When I go now I do so on the old mare that won't give me any trouble. Thanks again!
I was told to not even look up at the sky! Be very careful driving...whiplash is a big cause of paralysis in a compressed spinal cord. And I'd be VERY careful riding. One hit to the head and you could be paralysed.

The problem with compression is the blood supply. Once the blood supply is compromised, paralysis takes place in a matter of minutes. So if you get into a fender bender and your head flies back suddenly and for a second or 2 your cord is compressed even further, you could end up with paralysis because the blood flow was cut off. Same with falling off a horse and hitting your head. You don't need to sever a cord to end up with paralysis. Most are just crushed to the point where the blood supply is cut off. When my neurologist saw my MRI she showed me the problem...it looked like a pancake in one area. She said if that had happened during an accident, I'd be paralyzed but since it had happened slowly over the period of many years I wasn't.....but showing signs of developing it. They couldn't even put my head back to intubate me for anesthesia.....had to be done a different way.

So yes, be very careful now that you know what is wrong. And I'd suggest doing the 2 areas so you can avoid a second surgery in a year or 2. I'm facing my 3rd in less than 3 years and NOT looking forward to it.

Good luck.................Jenny:wave:
[QUOTE=jennybyc;3975979] And I'd suggest doing the 2 areas so you can avoid a second surgery in a year or 2. I'm facing my 3rd in less than 3 years and NOT looking forward to it.[/QUOTE]

I would agree. If you know the second level is going to have to come out anyway, you may as well get it all done at once. That means only once in the hospital, once in the collar, once time taking off work, etc.
Thanks, both of you for your replies. I was afraid of the paralysis risk but didn't know if I was being over dramatic with that line of thought. Also thought maybe my regular Doc (who is an osteopath and has treated me for over 20 years, including my spinal issues) would have advised me to be careful after he read the MRI and told me to go see the neurosurgeon.???

I'm anxious for my appt. date to get here! 8 more days. Is it likely that he'll require additional testing before making a decision on the best way to go?

Another question: I would like to check out information regarding the doctor and hospital concerning infection rates, errors, number of cervical surgeries, etc. Does anyone know how to do that? The infection rate is of particular concern to me as I am at higher risk of acquiring MRSA (antibiotic resistant staph infection) if I have surgery because I had two skin cancer surgeries that became infected with MRSA a couple of years ago. Not something I want to repeat again.

I appreciate this site and the ability to talk with others. And, I like the ability to do the research on my own so I'm somewhat knowledgeable when I do go for my appt. This is the first time I've ever posted on any kind of board so I'm a real newbie in that regard.

Thanks again...
All I can say since I am not a doctor is compare your MRI language to mine which says
"at c5-6 there is a right paracentral disc herniation. There is mass effect on the ventral surface of the cervical cord in the right exiting nerve root. There is mild left neural foraminial narowing secondary to uncovertebral osteophyte formation"
Now one surgeon says "you need surgery no emergency but I would get it done" another surgeon said "get the surgery ASAP"
I have numbness in both feet and pain in the shoulder and I don't know what to do probably look for opinion 3. Hope this helps it does appear to me you have a more serious condition.
TATA....I also had one surgeon say wait a while and one say do it ASAP. So I asked a neurologist what to do since they can't do surgery and have no financial gain from their decision. The neurologist said do it ASAP. Once you have numbness they may not be able to restore feeling but the surgery can keep it from getting worse. I had the numb toes, the stiff legs, the clumsy hands and the beginnings of numbness and loss of function all over the place in weird places. I woke from surgery with almost all feeling back...just my toes stayed a little bit numb.

So I'd do it ASAP just to keep it from spreading. I've had yet another disk go in my neck(C2-3) and have found this time I am losing sexual response. Yes, this neck problem can cause impotence in men and women. Not something you want to happen.

Or...do as I did...consult a neurologist for your 3rd opinion.

best of luck...........Jenny
Thanks Jenny I have a stand alone neurologist as well none of that side effect stuff for me I am only 54. I still ride a bike and run everyday albeit in pain this year. All the best thanks for the reply.
TaTa....I was only 54 and very active when I found out the strange sensations I was experiencing were from my neck. In fact, I was out shoveling snow. I shoveling the entire driveway by myself and then started around the house. Hubby's big snow blower is too big for me to handle so I do it by hand(it was only 10"). Then all of a sudden I must have taken one shovel full too many and I felt a strange numbness all over my body and stopped immediately. I knew that was not good and was not about to ignore it. However, I did wait a month to see my doc and he ordered the MRI. I was so bad he made me come to the office to tell me about it and what I needed. I was in total shock as I had no pain. Had been in a car accident 20+ years earlier with whiplash but this was a shock. Three levels of cord compression and arthritis all over the place. Ended up with 6 fused vertebrae and headed for more.

So lack of symptoms is no guarantee that you aren't in trouble. In fact, my neurosurgeon said he sees that a lot and it's those people he worries about the most. We don't know we are in trouble until it's too late.

So watch and be vigilant.

good luck.....................Jenny
Finally! Had my appt. Neurosurgeon said I'd need to have 2 discs removed and 2 fusions at C5-C7. He said I was not a candidate for either the artificial discs or the minimally invasive surgery. The procedure is called ACDF. He suggested that I try some neck traction and PT to see if it helps. I think he wants me to know going into surgery that I tried all other options first.

Has anyone tried neck traction and did it help? I can see how it may make some more room in the spinal canal but don't see it being a long term solution..

Thanks for the help!
The neck traction may potentially help a little by opening up enough space for that disc to receed and get it off your spinal cord. However, traction is not going to make the bone spurs go away. Sometimes the rubbing on the nerve by the spurs during traction will actually make your symptoms worse. If you search the old posts here you would find most people have very little luck with the traction. It is one of the things on the conservative measures list. If you decide to try traction ask your physical therapist to go very slowly adding weight/pull slowly.

Insurance companies are rating all the surgeons on if they tried the conservative measures first. I think for some they know it is a definite surgical case, but need to follow the protocols.

Your case is consistent with everyone around here that ends up fixing it, with such a compression on your cord it would seem you should know in a week or two if the PT will do anything for you - I do think surgery is in the cards for you. If you are really comfortable with your surgeon, I do not think there is a lot of grey area in your case from how you describe it, so I personally wouldn't seek another opinion. Mostly that is for looking if there are alternatives like minimally invasive, or artificial disc, etc.. For you it seems pretty obvious these are not for you.
I just had a 4 level cervical fusion with bone implants and Titanium plate a month ago. I really didn't have too many symptoms of numbness in the legs, hands or fingers but was having neck pain (felt like tension headache) and numbness in my left shoulder and was feeling weak or sick. I figured it was a bum shoulder from an old football injury. I was kind of right, it was an old injury but the problem was in my neck. I had an elective MRI after getting a clean report on shoulder and tons of blood work. The MRI revealed severe spinal stenosis with narrowing at C3/C4 to 7mm, C4/C5 to 8mm, C5/C6 to 7mm and C6/C7 to 5.5mm. The surgeon said the 5.5mm was dangerous and said I needed to fix that immediately. He suggested getting it all in one surgery and I ended up with a 4 level fusion from C3-C7. The weakness and pain went away immediately, I mean when I stood up 2 1/2 hours after surgery I was a new man. All my energy returned and I felt 100% better. I do have some stiffness in the neck and had some muscle spasms in the left shoulder once everything got woke back up. I will report again later if any of my syptoms change.

Roy
Thank you, both of you, for your replies.

NeckPatient, you have a good point on the bone spurs AND your reasoning behind the Doctor's suggestion to try traction first.

I was a little suprised that he didn't push more for surgery during that visit but your explanation makes perfect sense. I'll do a search on this site to see what luck others have had on the traction.

Roy, I hope your recovery continues to improve. Your post is encouraging.

Thanks!!
i totally agree with NP here on the NO TRACTION. having the compression upon your actual cord is the main reason here. the thing about having any pull or traction done with what you have, or alot of other potential spine issues is it is basically a 'blind' therepy that creates movement in an unseeable area, that can have miuch bigger consequecnces than most PT types of modalities. if something is going wrong in there during that pull, espescially within that very heavily innervated c spine area, you cannot tell til after the damage and movement has been done, you know what i mean?

if "all' you had was vertebrae that was out of alignment without any true cord compromise,it would of course be a much different story and could really help, but your cord is already being compromised right now, so going that route is just pretty highly risky for what you actually have going on. i would say thanks but no thanks to that one.

you DO need surgical intervention just to really 'fix" releive what you have going on inside that c spine area right now. everything that jenny told you is very much true when it comes to just having any cord compression going on. you just DO have a much more limited amount of cordspace than you should have. this would indicate a much more severe level of compression going on onto your cord are. this not only causes a rathewr limited amount of blood supply running theru that cord area,but that compression there alone is or could also be causing whats called myelomalacia to be occuring too. that is where the tissue starts to die off from just the more severe levels of cpmpression going on. this comes normally because of the blood supply issues and the fact that no CSF can actually keep that area of the cord bathed constantly with what actually kind of also keeps that very delicate neural tissue alive and healthy and also keeps it from dessicating or drying out. the one thing about cord/neural tissue is every tiny little bit of that cord tissue simply 'does' something or govens something in our bodies. any part of it that actually dies off or is being compressed for too overly long can actually kill it off and would show itself, unlike the brain where you can at times suffer pretty significant trauma and still not lose anything as far as abilitys or even mentation issues. that depends totally on just what area of the brain is being affected by real damage.

i would just be taking it really easy til you get this surgically intervened upon. this IS your cord ya know? i live with cord damage and have since 2003 and it does suck alot to have to deal with the after math,as jenny has told you about her crap too. if you can at all avoid it from ever occuring you are VERY lucky.

i am wondering about your scan? did they do another MRI on you and THEN decide to actually do that 3 tesla on you or was just what your doc actually ordered from the very beginning for you? its just kind of a more rare type of scan than MRI to have done without some other reason, like needing more clarity,than just a noral MRI that is much more commonly done, thats all. the only 3 T i had done ever was on my brain when they were trying to really identify a brain aneurysm. this type of scan just uses 3 times the magnestism for scan than any normal MRI does. thats why i am asking. Marcia
Thanks for the info, NP. I have been out of town for a few days and just got your reply. I am trying to do some more research on traction but it makes me nervous now. Why does the NS order it if it has the potential to harm?? It takes away some of the trust I have in him otherwise.

Does everyone else get tired of playing the healthcare / insurance game? The Dr. orders stuff he doesn't believe is needed/helpful to cover his butt. The PT centers perform therapy that probably won't change your outcome because they are a business and who would turn business away? On and on it goes. I just want honest upfront answers and then let me make my decision based on accurate information. Sorry, it is so aggravating! And I know I am lucky because I do have decent insurance coverage, at least this year. Next years premium increase will force a change so I really need to do what's needed this year.

As far as the MRI beinging done on a 3.0 Tesla unit, I didn't even know it was special till you asked about it. I don't know why. The imaging center I used is pretty new and has all of the latest equipment. So maybe it was just luck? Otherwise, my doctor could have ordered it specifically because we had a previous MRI done back in 2000 for some of the same issues I'm having now, like the arm & hand pain, tingling, numbness. That one showed some DDD and bone spurs but no stenosis in 2000. So, maybe since he knew I had those issues and he had already been working on me since first of Jan without results he ordered the Tesla??? It was probably just dumb luck.

Another question concerning ACDF's permanent restrictions after surgery. My Neurosurgeon's "permanent recommended restrictions " included not lifting anything over 25 lbs, forever. I hope that he is being overly conservative!! I'm wondering what other NS have advised regarding weight restrictions after you've healed? I have a 16 mo. granddaughter (she weighs 28lbs!) and a new one on the way in Nov. I know I won't be able to pick up my granddaughter for a long time after surgery I just hope it isn't really forever??

Thanks everyone!
Cathy
Oops! I meant to address last to Feelbad, not NP. Somewhere, is my brain. Maybe I'll find it ;)
quite honestly, whatever real lasting restrictions that get placed on you post op really has to take in sooo many other factors. i was under a ten lb restiction as soon as my herniation and my cavernoma were discovered in my spine and cord areas. this has never been lifted only because of the damage that has occured from my particular surgery. once your surgery gets done and you do some level of PT to just regain strength, THAT is when everything realistically would be reevaluated. not til then. my hubby went right back to firefighting post op after his disc surgery in about eight weeks time(light duty at first then back on the trucks soon after). i did the same profession but my case was it very very different than his and i could not go back to that job i loved so much.

i seriously would obtain a second opinion on all this just to get another point of view, ya know what i mean? i actually saw three sepertate NSs for my particular spinal cord issue and it was luckily ONLY the third opinion that actually had a real clue about what MY particular risks were to me and any prognosis too(my cavernoma inside my cord is just a very rare occurance). not great news, but at least i knew without a doubt i had covered ALL my bases ya know? most ins co will pay for second opinions, espescially when it involves the level of possible surgery you are looking at here with this.

if the right things are actualy done for you in all the right ways, and your cord compression has not actually left behind any lasting impacts, anything is indeed a possibility post op. no doc can really tell with 100 percent certainty with a condition like yours as to what real restrictions would even be there after the surgery on a permanent basis. there are just way too many factors that come into play there. if there is NO hint of actual myelomalacia going on within your cord right now that would have definitely shown itself with a tesla scan, things DO look a bit better for your outcome. this would just mean that your level of true compression has not yet created a stoppage of CSF around the impacted area and also the compression had not been hard enough to actually "kill off' healthy tissue either in the impacted areas. but this is why you need to get this all done BEFORE all of this just starts kicking in. most spinal issues are just very progressive in nature so anything you do, well the sooner the better, espescially with any level of real compression upon anyones cord.

just seeing another NS to see what they have to say would help alot for you in my opinion. any "predictions" made by any surgeon is kind of limited to their overall level of skill, knowledge and or experience in doing whatever needs to be done for you and your particular surgical issues, you know what i mean? their own level of skills and experiences and levels of of what they are even able to actually do for you, well that can impact the patient in many different ways(trust me,not all NSs or any surgeons are created equal). specialists espescially do not want to tell you they "can't' do certain procedures or will let their own egos dictate what actually gets done for you, their patient. if something is over their heads or they simply cannot actually do a procedure that would give YOU the better outcome, a good NS would refer you to the right NS for the job, but others, and that ego thing? well that alone could be limiting YOUR really true options, ya know what i am trying to say here? some people have actually had pretty resolvable spinal issues but because a stupid NS actually told them it was 'inoperable or impossible" to fix(but ONLY with that particular specialist and limited training and experiences), they just accepted it as truth when the specialist simply should have refered that patient to someone who actually COULD fix their level of spinal problems. unfortuently this does happen and it is a really sick thing to do to any patient.

if i were you,i would obtain at least one other NS opinion. i say NS only because that realistically would be the right type of specialist when it comes to anything within that spinal canal going on, or involvement of the cord. you simply do need to know ALL of your real true options and what any other NS may see as your possibles when it comes to post op prognsis's too. i personally know of people who have had much worse things going on in there spines than you currently do who went on, post op, to live totally completely normal lives with no real restrictions either. it all comes down to what IS truely impacted in that cord and what gets done surgically and how your post op PT course goes too. that is what kind of tells the real tale ya know? alot depends upon YOUR motivation and what you chose to do and keep doing, like some level of weight training too that would dictate what you can and cannot realistically do. ya just need to see how things are for you post op.

i do hope this helped some. but do try and seek out that second opinion. you just never really know what IS possible til you seek out other opinions. doing this for my situation saved me from becoming paralyzed by the first idiot who i saw. you DO have choices and options here, try and use them. Marcia
Thank you, Feelbad. You are right about the 2nd opinion. You make a lot of good points. I am going to make an appointment to do that today. Just as soon as I figure out who to call. :confused: I'm asking around for referrals.
And I totally understand about Doctor's egos getting in the way of what's best for the individual patient. They need to remember that these procedures may be a piece of cake for them (maybe even boring) but they can impact OUR lives for the rest of our lives.

I've seen and talked with people on both sides of the equation. Some who have not had good outcomes with surgery and others that praised the surgery. I had already decided that if I had to have surgery and fusion, then I would do everything within MY power for it to be successful. I don't want anything to go wrong that is the result of my action or inaction.

My other concern with this, or any other surgery, is MRSA (the antibiotic resistant staph) infection. A couple years ago I had a bout with it after 2 skin cancer removals - one on my arm and the other on my nose. The day after they were cut out I became infected in my arm which I got diagnosed pretty quickly. Went on a course of appropriate antibiotics, that cleared up but then nose became infected. Went on the meds again and it finally cleared. All told, on antibiotics for 4 months and both surgical sites had to be opened and allowed to heal from inside out. Not a nice scar. Compared to a lot of people's stories with MRSA, I was lucky. BUT, according to the infectious disease doctor I am at risk for it during ANY surgery (or anything that may puncture skin: injections, etc).

It still seems like a lot of people, including doctors and other health care workers, are not fully aware of the complexeties and insidious nature of MRSA.

Okay - I'm done whining. On to proactive things.

Thanks for the time and advice. It helps alot.

Cathy
BTW, what is a cavernoma and was it a result of your earlier surgery?
Google on OR Live and you can view the actual procedure on a webcast where the surgeon and a team answers many of your questions while doing the surgery.

Roy
Likea,

The ACDF procedure is available to watch online on a webcast (replay). It is Memorial Herman Soutwest's site on *O*R-L*i*v*e (less the stars). You can google and find the procedure for a 1 level ADCF. It lasts about an hour and has two moderators asking the surgeon email questions live during surgery.

Best of luck... the recovery continues. Basically very little pain just stiffness and and getting used to a little bit less range of motion in the neck

Roy
Roy, thank you so much for that link. I'll view it as soon as I can.

Good to hear you are knocking along. You had 4 levels - 2 more than what I need so I would expect you to have more stiffness in your neck. How is everything else going for you?

Cathy
Like I said earlier, I'm new to posting on message boards. I wasn't sure if I should start a new thread (which is what I decided) or continue on with THIS thread to ask new questions. Anyway, I started a new thread for questions I have after my 2nd opinion and after 2 wks of PT and traction. So check it out.

And if someone could let me know if I did this correctly? If not, instructions would be appreciated!

Thanks for all the input!
Cathy
I watch the operation online. I was a little "iffy" about watching it. Thought maybe it would make me more nervous about the operation but it actually was good for me to watch. Actually, I watched two different ACDF operations.

I recommend others to watch them also. I'm a little squeamish about cutting into flesh and blood but this was just fine. They made me a little less nervous about the operation.

Thanks for the link, Roy.





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