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#6453Topic: trying to understand my MRI in forum READING X-RAY, MRI & CT SCAN |
Good morning Sir if you could please interpret and explain my MRI to me I would greatly appreciate it. I am in severe pain everyday from the back of my skull on the right side shoulders and arm with numbness and loss of grip strength in forearm and hand. I have some minor pain and numbness on left side but right side predominant.
TECHNIQUE: MRI of the cervical spine was preformed using TI and T2 weighted sequences in multiple planes.
FINDINGS:Paraspinous soft tissues: Normal
Alignment: There is loss of normal cervical lordosis. Minimal retrolisthesis of C5 vertebra over C6 is seen.
Vertebrae: Mild degenerative endplate changes and Schmorl’s nodes are seen at few levels. Marginal osteophytes are seen at multiple levels. The certebral body heights are normal.
Discs C3-C3 & C3-C4 & C4-C5 & C6-C7 are dessicated and reveal mild diffuse bulges. They indent the anterior subarachnoid space without any significant central canal or neural foraminal narrowing. The bulges measure approx 2 mm in size.
Disc C5-C6 is dessicated and reveals a small broad based posterior herniation. It indents the anterior subarachnoid space, both C6 nerve roots and causes mild narrowing of the central canal and neural foramina bilaterally. The herniation is approx 4 mm in size.
C7-T1 is dessicated and is otherwise unremarkable
Mild generalized facetal and uncovertebral arthropathy is detected.
Spinal Cord: Normal in thickness and reveals normal signal intensity. No focal area of abnormal signal is detected within the cord. No intraspinal mass lesion is detected.
Impression:
1. small broad based posterior herniation of C5-C6 disc causing mild narrowing of the central canal and neural foramina bilaterally. Herniation measures approx 4 mm in size.
2. Mild diffuse bulge of C2-3 to C4-5 and C6-7 discs without any significan central canal or neural foraminal narrowing. These bulges measure approximately 2 mm in size.
3. Mild generalized facetal and uncovertebral arthropathy.
4. Minimal retrolisthesis of C5 vertebra over C6.Thank you for your help in understanding this. Deb
#6426Topic: l5s1 massive herniation in forum GENERAL |Dear Dr. Corenman,
I am 30 years old male in good athlete shape. I was injured with herniated L5S1 disc April 16th this year during my bodybuilding training in the gym. I felt a little bit of pain in my backs at the same day and after two days I could not walk. What is interesting I felt only pain in my lower back. I went to the doctor and he told me it might be a result of overexercising. I was prescribed some non steroids drugs with advice of the bed rest for two weeks. After few days I was in much better condition nevertheless I was feeling some pain in my left leg (outside thigh and calf). The pain was not so big so I could easily work 8 hours at my desk at work. I was a little bit worried with this small pain and I did MRI after consulting my doctor. It was done 13th May this year [hide]The results you can find under following image link:
https://plus.google.com/u/0/photos/101016139523903621227/albums/5757881451772698465%5B/hide%5D
In the meantime I have started physical therapy (exercises plus ultrasounds, TENS, laser etc). I visited three surgeons and they were really surprised of my good physical shape in relation what they saw on MRI scans (negative leg test, no muscles weakness). One of them advised surgery. The other two were not sure if to do surgery. Currently I feel a little numbness in my foot but it is not constant. It appears at the end of the day mostly. I am still missing Achilles reflex in my left leg. I have no constant pain in my leg. It appears rarely during the whole week.
I focused now on conservative treatment but I do not think it is the right way for me. Till now I was a really active person (playing squash, horse riding, some bodybuilding, running, skiing etc.) I partially came back to swimming and biking at the moment.
I was doing some research of the topic and read that in some of the cases the body can absorb the herniated disc. Do you think it is possible in case of such huge herniation as mine? I have read some articles that professional athletes (NHL, NBA, soccer player, even weightlifters) came back with success to their sports after microdiscectomy. Is it possible to reach the same level with conservative treatment?Thank you for your response in advance.
#6424 In reply to: about foraminotomy |Hi Doc,
Loyal reader…potential visitorI have read the indications for foraminotomy vs fusion including neck pain vs arm pain. I still do not fully understand. These questions are for c3/4 and c4/5.
You always ask about neck/arm pain percentage to determine foraminotomy vs fusion. C3/4) does not run down the arm and to the hand. Much of its journey is above the base of the neck. You have said it will radiate pain to the base of the skull and across the top of the shoulder. At this high level wouldn’t a symptomatic, unilateral, lateral herniation cause great one sided neck pain. Couldn’t a foraminotomy be indicated for neck pain in this circumstance?…….What about c4/5…same unilateral side?
Where there is a posterior disc (not hitting cord) and also lateral extension, and evidence that suggests the lateral part of the disc herniation is responsible for the unilateral nerve root symptoms, is it reasonable to attempt a foraminotomy in an initial attempt to avoid a fusion. (Images confirming of course)?
Can foraminotomy be performed on consecutive, same side levels(c3/4 and c4/5)?
Wouldn’t different elite doctors answer these questions differently?
Thanks,
___________________________________________________________________These are two radiologist descriptions at c4/5……(c3/4 is a lateral herniation).
c4/5 posterior disc osteophyte-complex without evidence of cord compression with mild narrowing of the spinal canal. There is bilateral lateral extension resulting in moderate neuoforaminal stenosis. (me….the posterior disc almost reaches the edge of the canal, the cord surrounded by fluid but thin on the disc side. The disc does not contact the cord)A second radiologist: At c4/5 there is mild disc space narrowing with partial dehydration of the disc. Posterior bulging of the disc is seen with anterior and posterior spurring. There is encroachment on the anterior subarachnoid space and left sided neuroforamen.
#6420 In reply to: loss of bowel bladder control due to cervical pain |It is still difficult to determine what caused the bowel and bladder dysfunction. If your father had a cord injury such as central cord syndrome (see website), it is possible to recover over time and that may be what is occurring. Make sure you keep your father from extension of his neck (bending backwards) to prevent further pinching of the cord.
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.QUESTION
Dear Doctor, I have a peculiar problem.Kindly go through this letter patiently and advise me.I was in dialemma and very disturbing. Does this vertigo resulted because of the middle ear problem or from spondylosis?. Or from small syrynx in spinal canal.?
PROBLEM
I am 69 year old male .I have cervical spondylosis from 1995. In December last while i was in bed, i have stretched my hands over my head and stiffened my hands to ward of lethargy. immediately after that when i got up, i felt dizzy and lost balance for the first time in my life.. since i have spondylosis, i immediately taken stugeron 25 mg and then gone to see ortho. He asked me to undergo MRI for cervical spine, since i have spondylosis for many years. Accordingly I ve gone for MRI of the cervical spine.He diagnosed it as postural vertigo (bppv). He asked me to take stugeron twice a day for 10 days and aceproxivon twice for 3 days. Besides this , accidentally , in the MRI he has seen a small syrinx at c4 and c5 level.He said not to worry about this, since it is asymptomatic and as i have never experienced weakness in limbs or pain in head etc. He further told me some elderly people have some abnormality and there is nothing alarming. It takes a long time to expand.He further said that it is most likely a cyst.I took the stugeron and aceproxivon. After that the vertigo lasted for about 16 to 20 days and subsided. In this period I felt spinning of the room while getting up from the chair or bed and also while turning sideways in the bed and while moving . I lost balance while going to the bath room. Again in May this year, I have again in the same position in the bed as in December , resulted again dizziness. Again i took stugeron for about 3 days but it was not subsided. Then on somebodys suggestion i ve gone to an ENT surgeon. He asked me to take Audiometry. Accordingly i took it and it shown 60 % loss in the left ear and 25 % loss in right ear. and apart from this some fluid secretion resulted in the middle ear and i am told that this is preventing the air to pass freely and it is building up the pressure and creating vertigo as my eushtachian tube is somewhat narrow.As such, he suggested me to take vertin 16 mg twice daily , allegra 120 mg one a day and ambrodil syrup thrice daily for 20 days .He further suggested if we implant gromets, the loss of hearing may be improved to some extent and the vertigo may also subside.But he has not given any assurance. Now the vertigo has gone. But at times, when i woke up from sleep in the morning I feel reeling or dizzy ness, particularly when i bend my head to wash my face in sink. I never had any head ache.
MEDICAL HISTORY
My medical history is as under: Had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then .
Had mild Hypertension in the year 1980 (under control)
Had prediabetes in the year 2010 (IFG) (under control)
Had subclinical hypothyroidsm in 2011
Medicines now being used
Heart * (from the year 1977)I have been taking Stamlo Beta 50 MG,(since 2006) Ismo 10 mg (since 1996), ASA 50 mg ,(since 191) TG tor 5 mg (since 2006) and glycomet 250 mg (since 2910)
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mri report
. Early changes of cervical spondyilosis with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any levelMild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.
A mall syrinx is seen at c4 and c5 level.Questions about the two problems
Now i would like to know from you first regarding VERTIGO …1. what are the other effective medicines in curing vertigo? 2.Do i have to take vertin as maintanence dose say 8 mg or 16 mg once day for the rest of my life to prevent vertigo? 3. what are the precautions i have to take when i go into the cold weather and travelling in an a/c compartment. 4.does this vertigo is a combination of middle ear problem and also cervical spondylosis? 5. If so do i have to take stugeron along with the vertin . 6. If so what is the dosage. 7.. How to differentiate the vertigo from spondylosis or from the middle ear problem ?. 8. Can the vertigo be cured permanently or do i have to live with it for the rest of my life? 9.Do i have to keep Vertin always handy? 10. Do I have to wear a cervical collar whenver i have dizziness?11.Do i have a cervical pillow while lying in bed?
Then regarding Syrinx . .1. Whether this syrinx has any bearing over vertigo. 2. Does this syrinx give me any problem at this age of 69 years or will it be dormant. 3.How much time does it take to grow? Already 6 months have passed after taking MRI. I did never have any symptoms through out my life so far. . Kindly advise me, as I wish to hear from you as an expert.Thanking you in advance.#6406 In reply to: MRI results |There are two things that you need to know that might have not been covered during his examination and explanation. The first is that by the sounds of your report, he did not check for long tract signs that could indicate irritability of the spinal cord.
These are Hoffman’s sign (flicking the long finger nail and looking for contraction of the fingers), hyperreflexia (exaggerated deep tendon reflexes elicited by the use of a reflex hammer), clonus (elicited by jerking the foot up quickly in a relaxed patient), Lhermitte’s sign (lightening electrical pain in the spine and extremities when the neck is extended), adiadochokinesis (inability to rapidly supinate and then pronate the hand), failure of the triangle test (inability to rapidly make a triangle on the ground with the toe of the foot while sitting) and positive Rhomberg’s test (inability to stand in one position with the eyes closed).
The second is that with a forced extension movement (bending the head backwards), there is a small chance that you could pinch your cord and develop a central cord syndrome (see website). The risk rises with skiing, mtn biking and other similar activities.
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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