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Hello:

I'm new to this board. For the last 6 months I've been experiencing left had weakness. I can't open my left hand without using my right hand to force them open. I had an MRI taken and saw a nerosurgeon that said I need surgery and recommends a Laminoplasty. Before I decide I have an appointment with a neurologist to see if there are non-surgical options. I'd appreciate input as some of the terms in the MRI report are greek to me. Here is my MRI Report:

PROCEDURE: MR Spine Cervical WO Contrast

HISTORY: 53-year-old male with numbness and tingling of the left arm.

COMPARISON: None

TECHNIQUE: Sagittal T1, T2, STIR and axial 2D GRE and 3D T2-weighted images of the cervical spine were acquired.

FINDINGS: There is subtle reversal of the normal cervical lordosis. No abnormalities of alignment are identified. The vertebral body heights are maintained.

There is focal hypointense T1 and T2 signal involving the C6 vertebral body, which may represent an atypical hemangioma.

There is hyperintense T2/STIR signal involving the C7 and T1 endplates and vertebral bodies. Multilevel endplate marrow signal changes are noted including Modic type II change endplate changes at C3-4 and C5-6.

The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No Masses or fluid collections are seen in the spinal canal or paravertebral soft tissues. The craniocervical junction is unremarkable.

Multilevel degenerative changes are indentified with diffuse degenerative disc desiccation and disc space narrowing, most prominent at C5-6.

The spinal canal is developmentally slender.

At C2-3, there is a small posterior disk osteophyte complex with mild bilateral uncovertebral and facet joint degenerative changes without significant spinal canal or neuroforaminal narrowing.

At C3-4, there is a moderate posterior disc osteophyte complex with mild bilateral uncovertebral and facet joint degenerative changes contributing to mild/moderate central canal stenosis with flattening of the ventral cord as well as moderate to severe left and severe right neural foraminal stenosis.

At C4-5, there is a moderate posterior disc osteophyte complex contributing to ventral cord deformity, as well as moderate right uncovertebral and facet joint degenerative changes contributing to moderate central canal stenosis as well as moderate right neural foraminal stenosis. There is no significant left neural foraminal stenosis.

At 5-6, there is a moderate posterior disc osteophyte complex with moderate bilateral uncovertebral and facet joint degenerative changes contributing to severe central canalstenosis with associated cord atrophy and myelomalacia, as well as moderate to severe bilateral neural foraminal stenosis.

At C6-7, there is a moderate posterior disc osteophyte complex with moderate uncovertebral and facet joint degenerative changes contributing to mild/moderate cental canal stenosis as well as moderate to severe bilateral neural foraminal stenosis.

At C7-T1, there is a small posterior disc osteophyte complex with moderate uncovertebral and facet degenerative changes contributing to mild central canal stenosis as well as moderate bilateral neural foraminal stenosis.

IMPRESSION:
1. Multilevel degenerative changes involving the cervical spine as detailed above, most prominent at C5-6 with severe central canal stenosis and associated cord atrophy and myelomalacia, as well as moderate to severe bilateral neural foraminal stenosis.

2. Hyperintense T2/STIR signal involving the C7-T1 endplates and vertebral bodies. While these could represent sequela of degenerative changes, early osteomyelitis/diskitis may have this appearance in the appropriate clinical sertting. Recommend correlation with prior MRI cervical spine examinations or correlation with CT scan of the cervical spine to assess for degenerative changes.
I find it REMARKABLE that you can have such severe spinal cord effects (flattening, deformity, myelomalacia) without any mention of disk bulges. In most cases, protruding or even herniated disks cause or at least contribute to canal stenosis. Your radiologist says nothing about them.

In fact, you seem to have only one degenerative problem, but it is severe and widespread. That is osteoarthritis resulting in bone spurs practically everywhere. Either you have been overstressing your cervical spine for a very long time, or you just have a hereditary tendency toward osteoarthritis. Maybe both.

However - and please note, because this is important to your case - the actual osteophytes are everywhere referred to as "mild" and "moderate", yet your spinal canal is severely affected. How can this be? It would be helpful if the radiologist supplied measurements both of the size of the osteophytes and the resulting size of the spinal canal. However, one can INFER that you have two basic problems, the degenerative osteoarthritis, AND hereditary canal stenosis. In other words, MILD deformities can have SEVERE spinal cord effects because your spinal canal started out too narrow and now the spinal cord has nowhere to "run" when osteophytes grow in on it from the front and the sides.

To give an example, a healthy adult male might have a spinal canal measuring 18mm AP (front-to-back). Within that canal is a 10mm spinal cord, with spinal fluid all around it. 3mm osteophytes impinging from the front and both sides will not necessarily affect the cord, because of the leeway provided by that fluid-filled 8mm of extra space.

In your case, you may have a 10mm spinal canal, with the spinal cord tightly fitted inside. Osteophytes growing in from the front and the sides will almost immediately affect the spinal cord, and, in your case, you have a LOT of osteophytes.

As to treatment.... the standard operation for cervical spinal problems is the ACDF. In a C5-6 ACDF, the surgeon would come in from in front, remove the C5-6 disk, substitute a shaped piece of donor bone in its place, then clamp the C5 vertebra to the C6 vertebra. You are then "fused" at the C5-6 level. Often, multiple levels will be done in one surgery, or over multiple surgeries. Some people end up fused all the way from C3 to T1.

In your case, however, the disks themselves do not seem to be the problem. Your problems are ubiquitous osteoarthritis, probably combined with hereditary canal stenosis. So it's hard to see how ACDF's would even help (and, of course, you would lose the range-of-motion provided by the fused levels).

The alternative to ACDF's is to come in from behind and "open up" the spinal canal to provide more room for the cord to escape the attack by the osteophytes. This used to be done (and, unfortunately still is done by some docs), by means of a "laminectomy", where the bones on the back of the spine (the laminas) are REMOVED. This, however, can result in spinal instability, so people with multilevel laminectomies often have had to have posterior fusions done, as well.

The "laminioplasty" is newer (in the U.S., that is, in Japan it is decades old). In what's called an "open door laminoplasty" the surgeon comes in from behind and cuts through the lamina on the most-affected side, swings the lamina backward to open the spinal canal, inserts donor bone in the gap (usually), and clamps the whole thing together with titanium. This can provide and additional 6-8mm of free space for the spinal cord to move backward and away from the osteophytes.

So a laminoplasty would be directly addressing one of your two basic problems, which is the hereditary canal stenosis. As for the osteophytes, the surgeon should trim them back wherever he can during the operation. He should be able to address the facet joints and maybe the uncovertebral joints. I don't know if he can do anything about the disk/osteophyte complexes, because they would be hidden in front of the spinal cord.

So, I hope you will read the "Cervical Laminoplasty Chronicle", because there's a lot of info there to consider. I wrote it with you in mind, but would rather not re-write it all here.

If you have any questions, please ask. Please also keep in mind that I am just an interested, semi-informed and somewhat-experienced AMATEUR.
I am also posting My MRI ,
I am going to the Neurologist Oct 16, I could use some help with questions for my Dr., so that I could understand my problems ,
My pain is constant.

Thank you

Examination performed 14/08/2012 at 08:30

REQUISITION #: RA2011106158

MRI OF THE CERVICAL SPINE :

CLINICAL HISTORY: Follow-up myelomalacia in the cervical spine.

COMPARISON: MRI from December 23, 2008.

FINDINGS:

CERVICAL SPINE:

There is mild retrolisthesis of C4 on C5 and C5 on C6, mildly progressed when compared to previous, on the basis of degenerative changes. There is reversal of the normal lordosis in the upper cervical spine.

Some edematous changes are seen within the endplates subjacent to the C5-6 intervertebral. Edematous changes are also noted in the left C7 superior articular facet, pedicle, and lamina. The remainder of the bone marrow demonstrates no significant abnormalities.

Unremarkable craniocervical junction.

C1-2: Unremarkable.

C2-3: Left facet arthrosis without sequelae.

C3-4: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the right. The central canal is borderline narrowed at this level. There is moderate right-sided neural foraminal stenosis.

C4-5: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the right. Mild ligamentum flavum hypertrophy is seen at this level. This results in mild central canal stenosis as well as moderate-to-severe right and moderate left neural foraminal stenosis.

C5-6: There is central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis. This has progressed compared to previous. There is mild ligamentum flavum hypertrophy at this level. These changes result in moderate-to-severe central canal stenosis, indentation of the thecal sac and flattening and deformity of the anterior spinal cord. No gross myelopathic changes are seen, however. There is moderate-to-severe bilateral neural foraminal stenosis.

C6-7: There is a central-paracentral disk-osteophyte complex as well as bilateral uncarthrosis, worse on the left. There is bilateral ligamentum flavum hypertrophy at this level. This results in mild left neural foraminal stenosis. No central canal stenosis.

C7-T1: There is diffuse disk bulge with a small central disk protrusion as well as ligamentum flavum hypertrophy. There is advanced left-sided facet arthrosis with associated edematous changes within the left pedicle and lamina and superior articular facet of C7. There is mild left neural foraminal stenosis. No central canal stenosis.

IMPRESSION:

1. Interval significant decrease in size of the colloid cyst, currently measuring less than 2 mm in keeping with either spontaneous resolution or interval surgical intervention.

2. Multilevel degenerative changes in the cervical spine demonstrating progression compared to previous, mainly at the C5-6 level, where there is moderate-severe central canal stenosis with slight worsening of the retrolisthesis. No myelopathic changes are seen. New bone marrow edematous changes in the posterior elements of the left C7, presumably due to worsening of facet arthrosis.





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