@ab6540183 Alfred, It's very unlikely that spine professionals wold be reading discussions here as they just don't have time with their workload, and wouldn't be able to offer medical advice without physical examination and imaging just based on patient comments. I think I can help you understand your reports. I'm sorry you are going through all of this.

The MRI is more descriptive of your condition. One question I have is which came first, this imaging or the spinal injections? You described having increasing pain around C7/T1/T2/T3. The report describes a mass at the T2/T3 foramen (space between vertebrae where the nerve roots exit the spinal cord) suggesting a nerve sheath tumor. Do you know where the spinal injection was placed? Was it in that location?

The spinal cord floats inside the central canal in spinal fluid so it can glide as you move and change your spine position. Think of it like a rope inside a garden hose and when you curl it up, the rope will move back and forth to accommodate the change in curvature. Stenosis means narrowing which happens when the canal is narrowed by damaged discs, bone spurs or an enlarged ligament. When it is advanced enough, it presses into the spinal cord and there is no fluid space left at those levels.

Spinal discs have an outer fibrous layer and the inside is like jelly to act as a shock absorber. With age, discs dry out and become stiffer and can shrink a bit. During an injury, the outer layer can develop minute cracks that over time with drying of the disc can open fissures and weaken the outer layer. If that ruptures, the jelly (nucleus) spills out of the disc as a herniation. This can happen many years after the initial injury.

Each vertebrae has facet joints that meet the facet joints of the adjacent vertebrae that allow it to slide when the spine twists and limit bending movements so the discs would not bear all the strain of bending. When a disc starts to narrow or collapse, more pressure is put on facet joints that then can become damaged with wear and tear and develop arthritis. Pain from facet joints is felt to the side of the spine. Facet joints sometimes catch and click and there can be pain with that if there are degenerative changes.

The ligamentum flavum is the ligament on the back of the spine that holds some tension. When it buckles as indicated in your report, it presses on the spinal cord from behind causing canal stenosis.

Foraminal stenosis happens when a ruptured disc spills into the space between vertebrae and also causes arthritic bone growth that compresses the nerve roots that are exiting the spine.

A disc osteophyte complex happens when a disc ruptures into the central canal and the inflammation causes bone spurs (osteophytes) to grow alongside it in an attempt to stabilize the spine. This starts to press into the spinal cord when it replaces the fluid space. Uneven pressure on end plates ( the top and bottom surface of the vertebrae adjacent to the discs ) also causes bone growth. When discs bulge or rupture, it creates this uneven pressure. If you think about pressing on a balloon and it is tilted toward one direction, the disc bulges away from the increased pressure.

Listhesis means one vertebrae is slipping past another. "Antero" means forward. Your C7 is slipping forward past your T1 by 2mm indicating that the disc is not strong enough to prevent that movement from happening. When that happens, effectively, the spinal canal become smaller. If there are also other things pressing into that space at that level, listhesis can cause symptoms to come or go depending on if the pressure on the spinal cord is changing.

You will need a very qualified surgeon for this. Many spine surgeons don't work on thoracic levels because of the lungs that are kind of in the way of being able to access a surgical path to the problem. You have both central canal stenosis and foraminal stenosis which is significant. Both of those will cause nerve compression leading to pain. The access to the central canal is through the disc space after the bad discs are removed, and they can clean out the foramen while they are in there. I don't know how great demand is for expert spine surgeons in Australia or how long the wait would be, but I might expect that this would be a priority case. Spine injections will not fix this, and may not help much. When they do them as a diagnostic procedure, the injection can reduce some inflammation and buy a little bit of space which might ease the pain, so it gives an indication of what surgery may be able to fix. The effect is usually temporary, and the pain comes back. When I had a spine injection, I got only 5 days of pain relief before symptoms gradually re-occurred. Also spine surgery is very expensive. If you need to fund raise for that, why not get started? Then there is the question of doing facet joint injections? That won't help the the moderate and severe foraminal stenosis that is crushing the nerves or the spinal cord compression caused by moderate canal stenosis. There may be pain from facet joints too, but the stenosis looks like the bigger problem and the only way to fix that is surgery.

You will need to advocate with your doctors and question them about everything and why they suggest what they want to do. It may not be necessary and may be just to validate the doctor's position. It makes more sense to discuss how surgery can help and how critical the situation is. Does it make sense to keep putting off surgery with other tests and injections when clearly you have spine issues screaming for attention? They do need to determine where your pain is coming from if possible, but they also need to address the functional problems that are evident in imaging. Obviously, they want to know that surgery would help the situation, but at some point, a decision must be made. I don't know if your financial situation is causing them to hesitate for fear of not being paid. I hope that is not delaying your care. Often surgeons don't promise to improve the pain; they promise to address the functional problems so that the condition doesn't deteriorate further.

Do you have a referral to a spine surgeon and a scheduled appointment?

Jennifer