[dreagarland]

#8767

Thanks for an extremely comprehensive and informative site.

Yesterday I received the results/radiologist interpretation of the cervical MRI conducted on May 7, 2013, and while I pretty much understand the general gist of the interpretation as explained by my GP, it’s hard to remember all the specifics and while extensive research via google has enabled me to fill in some of the blanks, I would very much appreciate it if you could give me your interpretation of the result and answer a couple of quick specific questions.

As a little background, I was diagnosed with rheumatoid auto-immune disease in January 2012, but am seronegative – and have also been diagnosed with hypothyroidism and vitamin D deficiency (causing overlapping symptoms). While physically examining my spine and joints, my doctor mentioned the possibility that I have a “touch of fibro” and also mentioned connective tissue disorder (though latest blood work showed I test negative for lupus).

I have had peripheral neuropathy issues and symptoms starting back around 2010, which we first suspected to be related to carpal and ulnar tunnel compression (I am a graphic/web designer as well as hand crafter, consequently have spent years conducting repetitive motion activities).

The peripheral neuropathy symptoms include numbness/tingling, etc. now present in all fingers and both hands, until recently set off if I maintained the same position for more than 5-10 minutes, but now is pretty much constant. Also have same issues with feet/toes, parts of legs and occasional numbness in thighs and buttocks (I have herniated lumbar discs and persistent sciatica). Fingers also often become icy cold, most usually pinky and ring fingers.

I also have muscle weakness and some coordination/balance issues, I often drop things and have a hard time lifting, grasping, etc. This past week I had a couple of episodes of extreme lack of balance upon waking up – had just received a u-shaped full length body pillow, which is wonderful for RA and spinal aches and pains, but I think the first couple of nights slept with my neck at an odd angle (and, ironically, due to amino acid therapy, have only very recently been able to sleep more than an or or so at a time without waking up due to pain) – upon waking up was extremely unbalanced, basically careened off the side walls of the hallway on my way to the restroom (after receiving MRI results, I suspect this is due to straightening of the cervical lordosis?)

While my neck “crackles and pops” I do not have constant pain in my neck region. However, after conducting activities that require me to have my head bent forwards for any amount of time results in moderate to extreme pain in my neck and upper back.

Surgery has now been presented as my only real option, and my GP is very conservative when it comes to suggesting surgery, so I pay attention when he does – though he did say first I need to see a neurologist and have EMG and NCS testing conducted. Unfortunately, I am in the middle of battling it out with my new husband’s health insurance company as to whether or not I am currently fully covered, so I may not be able to do anything until January 2013 – thus, I am curious as to whether there is any kind of “timeline” I should be aware of – I know each individual is different and so I’m sure it’s hard to predict exactly how quickly further degeneration may take place, but if there’s any king of rough idea of how long I can afford to wait, that would be helpful!

OK, here are my MRI rests (btw, this was an open MRI, can’t afford traditional MRI out of pocket at the moment):

0.35 TESLA MR EXAMINATION OF THE CERVICAL SPINE PERFORMED WITHOUT THE ADMINISTRATION OF INTRAVENOUS CONTRAST MEDIA.

INDICATION

MR FINDINGS: Modic type changes are noted in the cervical spine. There is straightening of the cervical lordosis. Critical osseous central canal stenosis is not demonstrated. There are hypertropic changes of the uncovertebral joints and facet joints of the cervical spine with compromise of the right and left c5-c6 and c6-c7 neural foramina and right c4-c5 neural foramina. This is less pronounced than at the c4-c5 level than the c5-c6 and c6-c7 levels.

Intradural Strucures: The cerebellar tonsils are in unremarkable anatomic alignment position. The cervical spinal cord is unremarkable in appearance. I see no unequivocal evidence of ominous pathologic intramedullary or extra medullary-intradural defect.

Extradural Structures: The predental space shows no evidence of pathologic widening. The trans-alar ligaments how no evidence of pathologic thickening.

C2-C3 and C3-C4 Intervertebral Disc: There is mild desiccation of intervertebral disc with maintenance of disc space height and the peripheral margins of the intervertebral disc parallel that of the adjacent vertebral end plates.

C4-C5 Intervertebral Disc: There is mild desiccation of intervertebral disc. The disc space height is appropriate. There is focal protrusion of the intervertebral disc with annulus fibrosus tear without spinal cord effacement associated therwith as shown on series 2 image #5 and series 4 image #7.

C5-C6 Intervertebral Disc: There is moderate desiccation of intervertebral disc with maintenance of disc space height and posterior herniation of the intervertebral disc effacing the cervical spinal cord as shown on series 3 image #4, #5, and #6 and axial image #10.

C6-C7 Intervertebral Disc: There is moderate desiccation of intervertebral disc with maintenance of disc space height and posterior herniation of the intervertebral disc effacing the cervical spinal cord eccentric toward the left side of midline as shown on series 2 image #5 and series 4 image #13.

C7-T1, T1-T2, and T2-T3 Intervertebral Disc: There is mild desiccation of intervertebral disc with maintenance of disc space height and the peripheral margins of the intervertebral disc parallel that of the adjacent vertebral end plates.

The posterior longitudinal ligament of the cervical spine appears to be intact.

Paraspinous Structures: Ominous soft tissue paraspinous mass lesions are not appreciated. The paraspinous muscles are symmetric in appearance. Normal signal void is appreciated within the right and left vertebral arteries.

Prior Examiniations: Prior examinations of the cervical pine are not available for comparison or correlation purposes.

RADIOGRAPHIC SUMMARY:

1. Herniation of the C5-C6 intervertebral disc.
2. Herniation of the C6-C7 intervertebral disc.
3. Protrusion of the C4-C5 intervertebral disc.
4. Hypertrophic changes of the uncovertebral joints and facet joints of the cervical spine with foci of neural foramina compromises as above. This is most marked at the right and left C5-C6 and left C6-C7 neural foramina. Correlation with bilateral C6 and left C7 nerve root symptomatology is suggested.
5. Straightening of the cervical lordosis which may have a comonent of muscle spasm attendant the aforementioned advanced cervical spine pathology.

While I am interested in your general interpretation, also specifically curious as to “herniation of the intervertebral disc effacing the cervical spinal column” – have been trying to research exactly what effacing the cervical spinal column means – get the gist of it, but seems that other people’s MRI reports are more specific and include info regarding spinal cord compression?

I’ve also attached an image I pulled from the MRI – both my GP and I think that C4-C5 may actually be herniated as well, and I demonstrate some symptoms of compression of the C5 nerve.

Additionally, I demonstrate symptoms of compression of the C8 nerve (sensory changes of ring and little fingers, lower side of forearm, muscle weakness).

Also, does “advanced cervical spine pathology” mean what I think it does – as in, literally, the condition of my spine is “advanced”?

Thank you very much for any info you are able to provide!

Well, it won’t let me insert a link to the image, tells me the message is spam because a url is included, but I see no option to directly upload an image, only to link a url.

[Donald Corenman, MD, DC]

#8985

First, your symptoms as you are aware can cross over. Peripheral neuropathy can mask or even exacerbate cord and root compression symptoms so diagnosis can be difficult.

You had your images from a 0.35 Tesla MRI machine. This is an underpowered machine (normal machines are 1.5 Tesla and the machine I use is 3.0 Tesla). Imaging information from this machine can be deceiving but we will continue as if this information is precise and accurate.

Regarding spinal cord compression, the radiologist reports “Critical osseous central canal stenosis is not demonstrated”. However he or she goes on to report “posterior herniation of the intervertebral disc effacing the cervical spinal cord as shown on series 3” referring to C5-6 and “posterior herniation of the intervertebral disc effacing the cervical spinal cord eccentric toward the left side of midline as shown on series 2” referring to C6-7.

The term “effacing the cord” is generally a good descriptor for a spinal structure that “touches the cord” but does not compress it. I will assume that this radiologist is correct and you do not have myelopathy from cord compression therefore the symptoms you demonstrate do not originate from myelopathy (paresthesias, imbalance, loss of fine motor skills).

You do have foraminal stenosis (narrowing of the exit holes for the nerve roots), partially at C4-5 on the right and bilaterally at C5-6 and C6-7 “hypertropic changes of the uncovertebral joints and facet joints of the cervical spine with compromise of the right and left c5-c6 and c6-c7 neural foramina and right c4-c5 neural foramina. This is less pronounced than at the c4-c5 level than the c5-c6 and c6-c7 levels”.

This narrowing can cause symptoms of the C6 and C7 nerve roots. See the section on “Symptoms of cervical nerve injuries” under the topic “Nerve injuries and recovery” to understand what potential symptoms can occur.

An EMG can be helpful if performed by a meticulous neurologist as with a combination of peripheral neuropathy and possible radiculopathy, this test can help to differentiate the two different disorders.

“Advanced cervical spine pathology” is another term for CNS, one of my favorite terms (crappy neck syndrome just like CBS-crappy back syndrome). It means nothing by itself as many patients are walking around with CNS or CBS and don’t even know it.

Might you need surgery? I cannot answer as your symptoms need to be correlated to your structural pathology. I think the EMG might be helpful but a very thorough history and physical examination is one of the most important diagnostic tools for identification of your disorder.

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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