New MRI results, doctor on vacation

Posted by grigori @grigori, Apr 14 9:59am

I have had increased problems with my right arm, plus insane neck pain and headaches. I got the MRI my doctor ordered, and it has so many things in it, I don't even know where to start. I feel like I should be terrified.

Impression
1. Multilevel spondylosis in the t cervical spine as detailed above, most notably at C5-C6 with posterior disc osteophyte complex slightly eccentric to the left with mild mass effect upon the left ventral cord with moderate to advanced left foraminal narrowing and mild to moderate right foraminal narrowing. 2. Please see above for level specific details. 3. Nonspecific small focus of hyperintense T2 and STIR signal at the junction of the midbrain and pons, this is incompletely evaluated, if clinically warranted an MRI of the brain could be considered for further evaluation. 4. As above. All reports both verbal and nonverbal are conducted in the Central Time zone unless otherwise specified.

Narrative
Reason for Exam: Neck trauma or nerve root injury, neck pain, radicular pain in the right arm EXAM: MRI OF THE CERVICAL SPINE WITHOUT CONTRAST . COMPARISON: None. TECHNIQUE: Multiplanar, multisequence magnetic resonance imaging of the cervical spine was performed without contrast. FINDINGS: OSSEOUS STRUCTURES/ALIGNMENT: Vertebral body heights appear grossly maintained. Minimal retrolisthesis at C5-C6 and trace anterolisthesis at C6-C7 suggested measuring approximately 1.5 mm. Question trace anterolisthesis at C4-C5 measuring approximately 1.4 mm. No evidence of hyperintense STIR signal to suggest recent or unhealed fracture. Facet alignment appears maintained without substantial facet joint fluid. No convincing evidence of prevertebral soft tissue edema. No evidence of hyperintense STIR signal in the paravertebral soft tissues. SPINAL CORD: Allowing for the limitations of the examination no convincing evidence of signal abnormality in the cervical cord is suggested. OTHER: No cerebellar tonsilar ectopia or Chiari malformation. Nonspecific foci of hyperintense T2 and STIR signal at the junction of the midbrain and pons, and this is incompletely evaluated, consider MRI brain for further evaluation. Mucosal thickening in the partially imaged paranasal sinuses. Flow-voids are seen within the vertebral arteries. 1.8 cm T2 and STIR hyperintensity in the left lobe of the thyroid gland, further evaluation with nonemergent thyroid gland ultrasound is recommended for further evaluation. Scattered nonspecific nonenlarged cervical chain lymph nodes are seen bilaterally. The paravertebral musculature appears symmetric. Scattered nonspecific submandibular lymph nodes are also seen. INTERVERTEBRAL LEVELS: C2-3: Intervertebral disc desiccation. Small posterior disc osteophyte complex. No abutment upon the cord. Disc osteophyte appear slightly eccentric to the left. Ligamentum flavum thickening. Moderate left facet arthropathy. No substantial foraminal narrowing. Anterior posterior dimension of the canal measures 11.2 mm. C3-4: Intervertebral disc desiccation. Minimal posterior disc osteophyte complex without abutment upon the cord. Moderate bilateral facet arthropathy and ligamentum flavum thickening. Moderate bilateral foraminal narrowing. Anterior posterior dimension of the canal measures approximately 10.8 mm. C4-5: Intervertebral disc desiccation. Small posterior disc osteophyte complex partially effaces the ventral CSF space without abutment upon the cord. Moderate right facet arthropathy moderate-to-advanced left facet arthropathy. Ligamentum flavum thickening. Mild bilateral foraminal narrowing. Anterior posterior dimension of the canal measures 10.8 mm. C5-6: Intervertebral disc desiccation and mild disc height loss. Small posterior disc osteophyte complex with signal intensity suggestive of an annular fissure, slightly eccentric to the left causing mild mass effect upon the left ventral cord. Moderate to advanced right facet arthropathy. Moderate left facet arthropathy. Mild-moderate right foraminal narrowing and moderate to advanced left foraminal narrowing. Anterior posterior dimension of the canal measures approximately 9.3 mm. C6-7: Intervertebral disc desiccation. Small posterior disc osteophyte complex with probable central annular fissure. Moderate left facet arthropathy. No abutment upon the cord. Moderate left foraminal narrowing suggested. Moderate to advanced right foraminal narrowing suggested. Anterior posterior dimension of the canal measures 11 mm. C7-T1: Intervertebral disc desiccation. No significant posterior protrusion. No abutment upon the cord. No substantial foraminal narrowing. Probable mild left facet arthropathy. OTHER: There is mild prominence of the nasopharyngeal soft tissues, nonspecific with slight hyperintense STIR signal, clinical correlation recommended.

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@grigori Hello and welcome to Connect. I’m sure this is a bit unsettling to read your report. It is very detailed and because radiologists don’t want to miss anything, they report lots of incidental findings . Your doctors probably suggested that you have pinched nerves where they leave the spine, and this report confirms it, and also that there are a couple discs that are ruptured with some of the inner jelly leaking out. That causes bone spurs from inflammation and those are also present. With aging, discs do normally dry a bit. There is a ligament on the back on the spinal canal that is thickening.

My MRI was very similar to this and I had bone spurs pushing into my spinal cord. I did not have the pinched nerves where they exit the spine. My C5/C6 disc had collapsed by about 50%. I had a fusion that corrected this and it resolved all my pain.

People have different experiences with spine surgery and we all heal at different times. When I woke up from surgery, all of my preexisting pain was gone. I only had pain from the incision and surgical path.

I hope this can ease your mind. Try not to think about this until you see your surgeon. Your imaging is typical for a spine patient after a past injury like a whiplash.

Your surgeon needs to interpret this for you and explain how this can be fixed. I’m confident you will get an offer to fix this and decompress the nerves. I know this can be a scary position and I’ve been there too. I did a lot to work through and overcome my fear of surgery. I expected it to be awful, but it wasn’t that bad. I found I could manage without pain pills.

What you can do now is get organized at home so you won’t have to worry about chores. When you are healing from surgery it is exhausting and your body needs to sleep a lot.

When is your follow up with your surgeon? Will you be getting other surgical opinions? My doctor told me that was a good idea. I had 6 opinions.

Jennifer

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I also have similar results. Yoru spinal cord looks okay, and that's good, but of course confirm with your doctor. It seems it is always a question of surgery or not. I have episodes that scare my neuro but so far no surgery: I use steroids and baclofen.

I don't know what the T2 and STIR hyperintensity means and that would be an important question for your doctor. Googling it shows it might be related to edema/swelling

" T2 and STIR hyperintense lesions1are related to edema that is secondary to acute ischemic or inflammatory damage1. In routine SE imaging, lesions with prolonged T1 and T2 have competitive effects on signal intensity2. In STIR imaging, the effects of ↑T1 and ↑T2 are additive2."

Some of the rest is what some of us get with aging. Some of us lucky ones! So sorry you are suffering. I have bone spurs in the neck and my left arm is now quite a bit shorter than my right!

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@grigori - Jennifer has such calming good advice. As you normally age, many of the findings in your report materialize just naturally. Jennifer is right - get a second opinion (and more if needed). Ask your surgeons what symptoms you would exhibit for them to step-up a surgery solution for you. Then you can watch for those symptoms (and they might never appear).

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