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Spinal Cord Disorders Message Board


Spinal Cord Disorders Board Index


I'm back. Amazing what a good night's sleep does for dilated pupils! I can see! Hate these eye exams every few months!

Now for your back....as I do with everyone, an anatomy and medical terminology lesson first. The vertebrae in the neck are different from the ones in the lower back as they are smaller and from C6 up, have arteries to the brain going up both sides within the bone itself. The spinal cord comes down from the brain and has both white and gray matter just like the brain and a protective covering that contains spinal fluid. At each vertebra(except for C1) a pair of spinal nerves peels off the cord and exits from each side out to the body. They exit from a hole in the bone called the foramina. To the front of each vertebra is a disk of hard gelatinous material called a disk(or disc). This disk is enclosed in a membrane that can rip open and cause a "herniation" and the gelatinous material can escape but it usually stays attached to the main disk and just kind of oozes out in either a sharp little bubble(small tear) or a larger bulge(bigger tear). These disks can also dry out and shrink as part of arthritis or aging. The vertebrae themselves have small joints that join together to allow the amazing amount of movements we can make. Each vertebra is a joint against another vertebra, the facet joints are on the back of the vertebra and allow sideways twisting and then there are little joints within each vertebra such as the uncinate joint that allows more intricate movements.

They talk in your MRI about a "bony bar ridge" and I am assuming that is the same as it is in most joints....arthritis has caused the bone to wear down and formed a ridge of bone instead of a smooth even surface. Radiologists have their own language and depending on where they trained, may called things by a slightly different name but they all mean the same thing. So where they have said there is a bony bar ridge, picture a once smooth surface as having lost bone due to arthritis and left behind a ridge in the middle of the area that makes the surface unstable.

Another thing to know about arthritis is that sometimes it causes bone to fall apart and sometimes it builds bone where it shouldn't.

Compression of the nerves exiting the vertebra from whatever, is graded from mild to moderate to severe.

They list 2 vertebra together as they are concentrating on the joint that happens between 2 vertebrae.

So let's tackle the MRI and I'll concentrate on the stuff that causes symptoms.

C3-4...you have one of those bony ridges in the mid-right side that has caused thinning of the bone on the right side. This has resulted in the hole where the nerve goes out to close up slightly and some build up of bone within the central canal where the spinal cord is but it isn't touching the spinal cord. This should be causing neck pain and right shoulder/arm pain.

C4-5....here is your big problem. You have 2 of those bony ridges...one on the left and one on the right. Both have caused a thinning of the bone on the sides of the vertebra. The small uncinate joint has deteriorated causing more bone to have dissloved on the left side and then building bone in the area of the foramina where the nerve goes out. This is listed as moderate to severe which means the nerve there is in trouble. The right side foramina is slightly closed up so the nerve compression here is mild. It is also building bone within the spinal canal but only on the left side. It says the spinal cord has moderate impact(compression) but does not give the actual millimeters involved. A normal cord is 11-12 mms. And just to add insult to injury, you have herniated the disk at this level and it has ruptured backwards toward the spinal canal but is not touching it at this point(some good news!). This should be causing a lot of pain in your left upper arm, some right upper arm pain and a lot of neck pain from the instability of thinned out bone and a disk that is not working. The cord compression can cause problem anywhere below this level so you may have numbness or tingling or even muscles that don't work right in you legs or arms or both.

C5-6....Another one of those bony ridges but this one is all over the place making the surface rough. The hole for the nerve exiting on the right is again moderately narrowed. It is slightly narrowed on the left. No bone building in the spinal canal. This one can cause pain all the way down to your right thumb and some pain down to the left thumb as well.

Your entire upper neck has been compromised with a lot of bone thinning and rough surfaces. Makes those vertebrae rock instead of sliding over one another smoothly.

Spine surgeons, whether they be orthos or neuros, operate for nerve damage, not pain. When you have pain, you have a live, screaming nerve. But nerve damage is seen in loss of sensation(numbness, tingling, electric shocks, and loss of function(dropping things, trouble walking, muscle weakness, muscles not working like they should). It is those things that they operate for. So many patients go in complaining about their pain not realizing that the doc doesn't care about that. It's the other stuff and we kind of forget what that is.....it doesn't hurt. So start writing down all the losses you experience...dropping a plate, stiff legs, hurting a finger or thumb and you really don't feel that much. That is what gets them doing something.

I learned this the hard way. My first NS I saw at 9am. I was pretty good in the morning after a good night's rest. So I felt pretty good and found myself being totally dismissed in less than 15 minutes. So my neurologist explained to me what I just did for you and told me to get a late day appointment. She then had me go to another NS. I was walking like a drunk by the time I saw him and my arms were weak and fingers numb.....I was booked for surgery right away.

I would also advise not talking about fibro....you don't know if they are one of the docs who believes and has read the studies. Spine surgeons are "test people". They want MRI's...they want to see where the problem is. Fibro has no way to test for it just as most mental illnesses have no way to test for them, so they throw it into the category of a mental illness. Don't give them reason to doubt you. If you take any meds for it, tell them it's for the chronic pain from your neck. Tell them about fibro after surgery. And you might very well find out that your fibro was actually the pain of a bad neck. You could have pain from anywhere below C4 and that is most of your body.

You've already gotten 2 opinions but both were tainted. NS #1 you didn't know to tell him about loss of function and not pain. NS #2 sounds like he's breathed in a little too much anesthesia over the years. Find a spine surgeon...not just a neurosurgeon or orthopedist. Some here prefer orthos, I prefer neuros but have seen both, but make sure they have a practice dedicated to spine surgery only. This is an area where you need someone who does this all the time and knows where he/she is going.

So, what questions do you have? I hope this has helped.

Jenny





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