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I am a 49 year old active woman who has played a series of sports most of her life and has always been active. I have never suffered any sport related injuries other than be bucked off by one of my horses last year. Prior to that I had suffered a number of traumas to my spine as a child.
I have always had a stiff lower back and what I can only describe as a locking lower lumbar twice a year. These are now frequent and pain is constant when sitting or standing. I could never bend over without a burning sensation in my thoracic region and this would also result in a middle back lock if I stayed in that position for too long. Sitting at a desk to work would give me burning sensations in the next if I sat too long, probably made worse by spending weeks writing a book that went to publish,The first MRI findings were in my spinal consultant’s opinion of no relevamce to my symptoms. Degenerative disc disease which is purely age related and a Tarlov cyst at S2 which he believes do not cause any pain. I beg to differ on that one. I do not suffer any sciatica but I do now suffer from leg problems, balance problems, pins and needles in legs, hands and occasionally feet. My mental impairment is slowing and this has been quick to progress.
My 2nd Mri shows obvious old injuries to c3 and 4. There is a disc protrusion at C4 which although is not compressing on the spinal cord the indentation on the image is bad enough to think it could be causing some of my symptoms. I have thinned discs in the thoracic region which are wafer thin.
When viewing the axial view of the cord and the surrounding nerves I have noticed black holes in two of the discs. Is this normal? any advice would be appreciated as I have a long gap between seeing my spinal consultant
I always become concerned when lower back pain is present and the MRIs are noted to have “age related” degenerative changes. Yes, the spine can become degenerative with time and still be asymptomatic but there are specific signs on MRI that can be associated with pain but are ignored as “age related changes”.
Tarlov cysts are typically not related to leg pain. These “cysts” are dilations of the dural sac, the membrane that surrounds all nerve in the spinal canal and I have seen only once in all my years that these caused symptoms (I have seen hundreds of these cysts).
Balance problems can originate from compression of the spinal cord but not from compression in the lumbar spine. Paresthesias (pins and needles) in the “legs, hands and occasionally feet” are not related to lumbar spine pathology but can originate from the cervical spine among other origins. You have an MRI which does not note spinal cord origin so myelopathy can be ruled out.
Mental process slowing would not have anything to do with the spine but be either be originating from the brain or some metabolic syndrome (hypothyroidism or other origins).
If the “black holes” in the disc noted on axial images are not also seen on the sagittal images (side views), this would be artifact (aberrant findings that do not really exist). Don’t forget that anything that looks black on MRI could be bone, tendon, disc, gas or other structures.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Thank you for your speedy response Dr Corenman.
There are black spots appearing in the spinal cord of the MRI but until I am told different I am assuming that these are nothing as are the white blotches in most of the top cervical vertebrae. Thank you for explaining the possible link to the spinal cord compression and leg sensations. Logically this would also explain why I feel a little off balance when i try to rotate the neck backwards and sideways?
I have taken copies of all my MRI images and have stored them so that I can study them while the original is waiting to be read by my spinal surgeon on saturday.
The shade of spots depends upon many factors. The MRI does have artifact-spots or lines that occur due to motion of the patient, moving fluids (CSF) and volume averaging (the MRI will merge adjacent structures to make them look different). Cord injury typically will look “highlighted” (bright) on a T2 image (the one that makes water look bright).
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Many thanks for your earlier response.
I now have the report in on the latest MRI of the cervical and thoracic spine which reads as follows:
C5/C6 – there is a broad based central disc/osteophytic bar causing moderate narrow of the exit foramen. The rest of the cervical discs are dessicated but there are no protrusions.
T3/T4 – there is a left paracentral disc/osteophytic bar causing mild narrowing of the left exit foramen. There is no central or foraminal compression.
T4/T5 – there is congenital fusion
T5/T6 – there is moderate facet joint osteoarthritis
T7/T8 – small central disc protrusion but no central or foraminal compression. The rest of the discs are dessicated but there are no disc protrusions.
Early facet joint osteoarthritis
Normal craniocervical junction and normal cord.
There are multiple thyroid cysts likely to be part of a thyroid goitre.
No vertebral collapse but there is mild endplate irregularity in the thoracic spine but no MR evidence of scheurmans disease.
Conclusion – multi level degenerative disc disease but there is no disc protrusion causing central compression. There is narrowing of the exit foramen at C5/6.Having now seen the spinal consultant and the images on disc (I have a copy of all my MRI’s as I had to pay privately to have them done). His conclusion is that my spine is strong enough and the report in short is nothing to worry about at it is all age related and that I should resume riding horses and running marathons.
Interestingly you did give me possible pointers as to hypothyrodism being a possible cause of my mental sluggishness. In the UK the test for such is hit and miss and a negative can still be a positive. As I have only ever been tested once for thyroid problems he said that the cysts are nothing to worry about and do nothing about them.
In my first MRI carried out by another private hospital it was reported ‘ established Schueremanns Disease in the lumbar region.
I have come away very confused by all of my discussions with the spinal consultant and feel that I should accept that my spinal pain is nothing and the images are all age related. If I have osteoarthritis then why do blood tests tell me that I don’t and that blood tests for inflammation markers come up negative when I have these so called thyroid cysts, tarlov cysts and two fibroids in the uterus. The only changes in my blood tests are ferritin at 5, folic acid very low and glucose 18.8.
Sitting at my desk typing this sat in a good back supportive chair does nothing for the burning pain in my neck. If I try to rotate my neck to the left or right, slowly, the gristle sound is loud and I feel dizzy when I come back to a central position and it feels like my vision is slow to follow.
Where do I go from here? Should I accept what he says and do nothing more from hereon? Your advice would be appreciated.
” Age related changes” in the spine are a Health Care’s (national or private) way of using policy to ignore pain generators in the spine.
There are many (and some would say most) degenerative changes that are asymptomatic. It is also true that generally reading an MRI and X-rays of spine degenerative changes does not by itself prove the presence of a pain generator. I see many changes (bone spurs, nerve compression and even instability) that are non-symptomatic.
The key is the ability to match the symptoms to the pain generators and then treat the pain generators with the appropriate therapy. Diagnosis may be made with history, physical examination, imaging, diagnostic injections and other tests.
In your case, your neck symptoms could be generated by your cervical discs. The “gristle” noise you hear is probably from degenerative changes of the cervical facets (see website for cervical anatomy). This is where X-rays with flexion/extension views can be quite helpful. Alignment (lack of lordosis or discal collapse) with motion studies can indicate what structures are causing pain.
This requires a physician skilled in looking for these pain generators and possibly another who can diagnose (and treat) these generators with injections (see facet blocks and SNRBs on the website).
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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