[twice]

#21922

I am trying to understand an MRI finding. My doctor has not given it much interest, but doesn’t seem to be able to answer what it is. The report reads: “There is mild soft tissue about the dens likely reflecting a pseudopannus formation” I had virtually no luck finding the term pseudopannus but did find a few things about a pannus around the dens or odontoid pannus. Most search results seem to be about this structure in relation to rheumatoid arthritis, which I have not been diagnosed with.

My questions are:
– Is the pseudopannus formation likely the same as a pannus around the dens?
– Should I be pushing my doctor to take a closer look or possibly seek out another doctor or specialty?
– Can this be the cause of various cervical symptoms- they were looking for the cause of my wrist pain and numbness, but I also get neck and shoulder pain, a “crick” in the neck for lack of a better word where very thing just tightens up. Occipital headaches usually occur with this neck pain.

[Donald Corenman, MD, DC]

#21923

This pannus is called a “Pseudopannus” as it looks like a pannus but does not have the origin that these pannuses typically have (rheumatoid arthritis). A pannus is a mass of synovial and inflammatory tissue around a joint. If the C1-2 level is stable, then there is no cause for alarm. Stability means the dens is intact (not fractured or eroded) and the transverse ligament is intact-the atlantodens interval (the space between the dens of C2 and the front of the ring of C1) is less than 1-2 mm.

This pseudopannus will not cause arm symptoms. The origin could be gout or pseudo-gout (calcium pyrophosphate disease). You might get some tightness of rotation of your head. There is an unlikely possibility of headaches but this would be distinctly unusual.

You probably have some other disorders of your neck that are contributing to your symptoms.

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.

[twice]

#22218

Thank you so much for your explanation and sorry for the belated response. The explanation of what stability means in this context is really helpful. I assumed instability meant unstable, as in “wobbly” or hypermobility, and couldn’t figure out how one could know that from looking at just the MRI. Now I know what it means and it makes sooo much more sense.

I do have a tiny protrusion at c6-7 but it is just that, tiny, so I don’t know if that’s even possible to be responsible for the neck symptoms. But it looks to me that from the 2012 MRI to now it’s changed- there seems to be signal intensity in the protrusion. However, the 2012 MRI images are a bit blurry, so it could that more image clarity makes it more visible as opposed to a change.

One thing I’ve been wondering about is that I have two cervical MRI’s- one from 2012, and one from this year. The one from this year lists no findings. The one from 2012 has the finding of the pannus and had the tiny protrusion. I asked the ordering physician if that meant the protrusion and the pseudopannus from the previous report healed and went away. She gave me a kind of non-answer. Troubled by that, I spend some time figuring out how to view my MRI’s and finding those two features. Both still exist on the current MRI even though they are not in the 2016 report. I’m fairly confident what I’m seeing is what I’m seeing, I spent a lot of time staring at MRI films online to get a sense of what these things look like on an MRI. I’m not sure what to do or if this matters. I have not seen a neurosurgeon, but plan to due to a thoracic protrusion that is causing me lots of pain. I don’t want something missed because the most recent report doesn’t accurately reflect what’s there. What is the protocol for something like this? Does it matter?

Lastly, looking at the pseudopannus on the MRI- it does appear to press into the thecal sac quite a bit, though does not appear to impinge the cord. It’s very close though. If I’ve got the scale right (and that might be a big if), it appears there is somewhere between 1 and 2mm of space between it and the cord. Can this cause problems, now or if the pseudopannus should get bigger? This is part of the reason I’m wondering if I should be making sure my that the newest MRI report is accurate. I feel kind of lost; a friend who is a medical professional from another state commented recently how below par the care I’ve received here is. But I’m not sure what I can do about that but it does leave me with some doubt about leaving this discrepancy as is, unless it’s truly inconsequential.

[Donald Corenman, MD, DC]

#22220

The pannus being “close” to the cord does not really matter if there is plenty of space behind the cord. There is an acknowledged rule called “Steels rule of thirds”. At the level of C1, there should be 1/3 of the space for the odontoid, 1/3 of space for the cord and 1/3 of space for CSF. You probably are OK at that level.

Also, with different MRI machines and different radiologists, you can’t avoid different readings. What you need is a kind, verbose, educational spine surgeon or neurosurgeon who can go over your MRIs and fulfill the answers to your questions.

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.

[twice]

#22221

“What you need is a kind, verbose, educational spine surgeon or neurosurgeon who can go over your MRIs and fulfill the answers to your questions.”

Any suggestions on how to find one of those? I’m in Milwaukee, WI and travel isn’t an option unfortunately, or I know where I’d be going. I’ve been lurching and reading your forum archives for several months. Primary concern is a symptomatic thoracic herniation at t7-8. I’ve got a few recommendations from doctors I see, but they’re more of the “they’re in the same medical group as me, so here is who we recommend.” My reluctance to see one of those is that so far the medical professionals I’ve seen don’t have much experience with thoracic disc problems. The most common response is that it’s unusual. I also want someone to look at the cervical MRI, but that is of secondary concern. Even suggestions on how to vet a good spine surgeon would be helpful.

[Donald Corenman, MD, DC]

#22224

Finding a good spine surgeon is difficult. You can go through the section https://neckandback.com/treatments/best-questions-to-ask-when-interviewing-a-spine-surgeon/ to gain some knowledge about questions to ask but some surgeons might be put off when you ask about their qualifications.

Thoracic disc herniations are somewhat uncommon. In my practice, they occur less than 1% of all patients. The history and physical examination have to match with the pathology. You then need to get a selective nerve root block to make sure the HNP is the pain generator. This will identify the pain source and may even treat it. If surgery is necessary, there are many different approaches. I prefer the posterolateral approach but some surgeons are skilled at the VATS procedure (video assisted thoracic endoscopy).

Please keep us informed of your progress.

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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