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  • Donald Corenman
    Keymaster
    Post count: 52

    Can you tell me if my MRI results below warrant surgery? Several months ago, I had “electrical” jolts going down my spine. I still get them but very rarely. Nothing like before. I also have scoliosis in my thoracic spine, but that doesn’t concern me at this point. Thanks for your feedback!

    Multiecho and multisequence MRI of the cervical spine was performed. This included post contrast imaging after administration of 13 ml of Omniscan.

    The cervical vertebral bodies are in anatomic alignment. No vertebral body height loss or significant listhesis has developed. At C6-7, a relatively large soft disc herniation has developed at a sight of prior posterior annular tear; this results in a moderate degree of narrowing of the left hemicanal and is slightly eccentric to the left. The underlying left hemicord is mildly distorted. At least some of the herniated disc extends into the left foramen as well.

    At C3-4, a disc bulge is present with a posterocentral protrusion which results in effacement of the ventral CSF space and mildly distorts the ventral surface of the cord. The overall degree of spinal canal narrowing at this level is still only mild.

    At the remaining cervical levels, there are mild bulging annuli but no other significant findings.

    In the upper thoracic spine at the level of T3, it is noted that the thoracic cord is fixed to the ventral and rightward aspect of the canal which is of uncertain significance. No clear lesion is seen to account for this displacement of cord.

    IMPRESSION:

    1. Relatively large soft disc herniation has developed at C6-7 which results in distortion of the underlying cord and probably narrows the left foramen as well. This represents a significant progression in degenerative disease to the prior MRI.

    2. Other milder degenerative changes as detailed above.e block injection for the past 6 weeks none has help

    (posted by admin from previous format)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Reading an MRI through the eyes of a Radiologist always makes me nervous but I will let you know what I think. Is your only symptom “electrical jolts” down the spine which has significantly improved over the last few months? You do not complain of arm pain or weakness in your left arm, balance problems or problems with fine motor skills (handwriting and zipping a zipper). If this is correct- you most likely had a new onset herniated disc at C6-7 that originally compressed your cord but now is both shrinking down and your cord has accommodated. I can’t tell you the risk of future problems without knowing specific details.

    Dr. Corenman

    kdbatchelor
    Member
    Post count: 1

    Dr. Corenman,
    So glad I found your site !!! I have the exact problem you describe in Understanding an MRI in cervical nerve compression, except mine is on the left side. Very little if any neck pain BUT left arm pain, numbness, pins & needles, weakness, & etc. It radiates down my arm into my thumb and index finger. I had an epidural x1 in 2005 with great results, however everything returned gradually over the past 12-18 months. I am scheduled to have another epidural this Friday (05/20/2011). Would like your opinion on the epidural verses going ahead with the surgery to repair/remove the spurs and so on.
    Thanks so much for your site — world of information– If I lived closer I’d come see you :)
    Roll Tide Roll Yep live in Alabama
    thanks again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    I assume the nerve root compression is at the same level as the original compression. It is very good that you have no neck pain as your options are expanded. The symptoms that radiate into your thumb and index finger most likely indicate the C6 root (at C5-6). If you had a herniation at that level before, you probably have a combination of herniation and spur now.

    Cervical surgery has four indications; Myelopathy (compression of the spinal cord), weakness of important motor groups (a C6 nerve would go to the biceps and wrist extensors), instability and pain that is not tolerable. Surgery for weakness is more of a value judgment but recovery of motor strength after surgery is not guaranteed. It is therefore probably better to not wait if weakness is a major factor.

    Pain is the major surgical variable. If pain, numbness and paresthesias (pins and needles) are the only complaints, a program of physical therapy and nerve injections (SNRB- see web site)can be effective to control and manage the symptoms.

    If the symptoms are intolerable, then surgery is warranted. Your choices are an ACDF (decompression and fusion) or an artificial disc. There are benefits and drawbacks with each (again- see website for descriptions of these).

    Hope this helps.

    Dr. Corenman

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