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Spinal Cord Disorders Message Board

Spinal Cord Disorders Board Index

Here's the cervical MRI taken before my laminoplasty a year ago. I'm posting this because I got three different surgical recommendations from the three surgeons I talked to, and they were all looking at the same MRI. One wanted to do a bi-level ACDF (C4-5, C5-6). One wanted to do an ACDF at C4-5, then follow up with foraminotomies. The third wanted to do a C4-5-6 laminoplasty with accompanying foraminotomies, which is what I decided to do.

I'm also posting this because because I've seen a lot of radiologist's reports posted here which were inexcusable and useless garbage, and I wanted to show what a report should look like when done by a competent and conscientious radiologist (and, no, I've never met the guy).

I interspersed my own notes in [] inside the report, which follows.......

1. A short pedicle configuration of the spinal canal on a congenital basis adds to the significance of the acquired disk disease.

[ The pedicle is a bone connects the lamina to the vertebra, and acts as a "spacer". If it is short, the spinal canal will thus be narrower.]

2. At the C3-4 disk space, anterior fusion graft and interbody screws and metallic fixation plate are in place. There is a short pedicle configuration of the spinal canal and a persistent 2mm bridging osteophyte contributing to minimal spinal stenosis. There is minimal myomalacia of the right lateral aspect of the cord with increased signal intensity at approximately 2-3mm in length and 1mm in diameter seen in the right dorsolateral cord.

[ He refers to the hardware from a C3-4 ACDF I had 15 years earlier. This was due to a very severely herniated C3-4 disk. The myomalacia (permanent cord damage) was also a result of the herniation. That myomalacia means that the muscles of my right hip and leg do not have as many functioning fibers, which has resulted in some weakness and atrophy. This is only apparent to a trained eye, looking closely, although I am somewhat aware of it.]

3. At the C4-5 disc space, which is desiccated, there is evidence of a 2-3mm broad-based bridging osteophyte, and hypertrophic change to the ligamentum flavum with severe spinal stenosis and compromise of the cervical cord. The sagittal dimension of the canal is reduced to less than 5mm. Hypertrophic change to the bilateral, particularly the left uncovertebral joint is present with severe left and moderate right foraminal stenosis.

[ I had a left-side foraminotomy done eight years earlier, and I'm pretty sure it was at C5. So the foramen at that level is back to "severe" already?? If I recall, the problem before the surgery was from the facet joint, but now it's from the uncovertebral joint.]

[ When I had my C3-4 ACDF done 15 years earlier, the surgeon pointed to the problem at C4-5, and predicted that I'd need surgery in five years. Lasting 15 years is pretty good. While some may consider my C4-5 problem evidence of "adjacent disk syndrome", I actually see it as the opposite. Keep in mind that the ligamentum flavum was also encroaching from behind, so what little change occurred in the bridging osteophyte over 15 years is hardly anything out of the ordinary. ]

4. At the C5-6 disc space, which is desiccated and narrowed, there is a 3mm predominantly left lateral bridging osteophyte and hypertrophic change to the uncovertebral joint with severe left foraminal stenosis. There is minimal central canal stenosis with only minimal flattening of the left ventral aspect of the cord.

5. At the C6-7 disk space, which is desiccated and narrowed, a 2mm bridging osteophyte is present. There is no significant spinal stenosis. There is hypertrophic change of the uncovertebral joints with minimal to moderate bilateral foraminal stenosis.

6. At the C7-T1 disk space, which is desiccated and narrowed, these is hypertrophic change to the right uncovertebral joint with minimal right C8 foraminal stenosis. There is no central canal stenosis.

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