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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

For starters, I have to say that's a LOUSY radiologist's report. He shouldn't have been paid for that. In fact, he should be fined and censured for turning out crap like that. Either he's lazy and indifferent, or he doesn't know enough about what he's looking at to make decent commentary. Let me see what I can do with it, though...

<< curious if u are a physician or radiologist >>

Neither one. Just a guy who's had three cervical surgeries over 16 years, looked at a lot of MRI's, read a lot of reports, and researched things a little. So you should, of course, keep in mind that I'm an amateur, and I can only supply background.

<< C2-C3: There is broad osteophytic spurring. There is left c3 neural foraminal stenosis. The right c3 neural foramen is patent. >>

So you have bone spurs at these levels. The R doesn't bother to tell you WHERE they are, but I guess he didn't think that matters. "Foraminal stenosis" literally means "narrowing of the opening", and refers to the opening (foramen) in the bony cage of the spine through which the peripheral nerve leaves the spinal cord and heads off to the neck, shoulder and arm. The C3 nerve leaves from the C2-3 level. You might want to find an online graphic of this, because your problems seem to be entirely foraminal in nature.

<< C3-C4: There is bilateral uncovertebral joint hypertrophic change. There is moderate spinal canal stenosis (axial T2 image 8) and bilateral C4 neural foraminal stenosis >>

The uncovertebral "joint" is a formation on the side of the vertebra that stabilizes the spine when bending and twisting. Hypertrophy means that you're laying on extra bone there, which could eventually interfere with the nerve pathways (foramina). Something is pushing into the spinal canal (which holds the spinal cord), but the R doesn't say what. He also doesn't bother to indicate the severity of the foraminal stenosis.

<< C4-C5: There is a broad-based disc osteophyte that flattens the ventral margin of the thecal sac, causing mild spinal canal stenosis. There is also bilateral C5 neural foraminal stenosis. >>

A "disk osteophyte [complex]" is where, over long time, the parts of the vertebrae where they interface with the disks start to form bone spurs which push backward into the spinal canal and into the foramina. Sometimes the disk itself is also bulging out. The "thecal sac" is the membrane enclosing the spinal canal, and at this level it is being pushed on by the osteophytes. The R is kind enough to tell us he thinks the effect is "mild" (nothing to worry about, yet) there, but can't be bothered to supply an adjective to the foraminal stenosis.

<< C5-C6: there is a broad -based disc osteophyte that causes mild spinal canal stenosis and bilateral C6 neural foraminal stenosis. >>

Same thing at this level.

<< C6-C7: There is a prominent central disc protrusion and there is a broad osteophytic spurring. There is moderate spinal canal stenosis and moderate, bilateral C7 neural foraminal stenosis. >>

OK, at least here he bothers to use adjectives. At this level the disk itself is pushing out in addition to the osteophytes. "Moderate" is one step below "severe", and means the R thinks this is worth a close look. Just because you have CANAL stenosis does NOT mean that your CORD is affected, though. You have some leeway in the canal where the spinal fluid surrounds the cord. A halfway-decent radiologist would have told you that you either do or do not have cord involvement. (can you tell I'm pissed at this guy?)

<< Impression: Diffuse sppondylosis causing multilevel spinal canal and neural foraminal stenosis. Findings are predominantly bilateral. >>

Just awful. This guy should be sentenced to picking up trash for a few months so he can think about maybe earning the $100's he's collecting for each hour of "work".

<< So this is it, however the neurosurgeon didn't agree w/ some of the report saying that c3-c4 were severe and c5-c7 were moderate, so i don't know??? waiting to see the other neurosurgeon for a second opinion. >>

I'm sure the NS is much better at reading cervical MRI's than the R. In fact, I've had two NS's tell me they don't even bother reading the R's reports. The NS is clearly disagreeing with the R as to where the worst level is.

In summary, though, I am VERY surprised that a surgeon wants to fuse from C3 to C7. In fact, I'm surprised he wants to fuse ANY level. I must repeat, though, that I'm basing this on the R's report, which I've already said is lousy. I'm not looking at the images and, even if I were, my opinion isn't worth much more than you're paying for it. Still, C3-C7????

You REALLY need TWO more opinions, and from the best surgeons you can find. You need to look into two other kinds of surgeries, also. The first is the foraminotomy, which is the least invasive cervical surgery and is simply to carve the bone spurs that are growing into your foramina. Since your problems are multi-level and bilateral, you might need several foraminotomies. I don't really know how much they can accomplish at one time. Still, one HELL of a lot less intrusive than fusions, and with no lasting damage.

The other operation is the laminoplasty. This is an op for people whose spinal canals are too narrow to start out with. The surgeon goes in from behind and opens up the canal by swinging one side of the bony cage (the lamina) out and propping it open. He can do 3-4 levels at a time, and can, in the same operation, do foraminotomies where needed. Many American surgeons do NOT KNOW HOW to do laminoplasties, so they won't even tell you they are an option. They've been done for decades, though, in Japan.

I have had all three operations (C3-4 fusion, C5 foraminotomy and C4-5-6 laminoplasty) so I do know something about it.

See if you can get a couple of names for Boston surgeons from Jennybyc. She knows the best. Get TWO more opinions. I mean it. TWO. If you have to pay out of pocket, don't think twice about it.

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