Results Of Mri Scan

[Preacher]

I had a MRI scan of my spine made, and the radiologists saw the following:

- central posterior protusion of the C3-4 disc with indentation on ventral aspect of the calsac

- mild central posterior protusion of the c4-5 disc with slight indentation on the ventral aspect of the calsac, less than C3-4 level

- broad base posterior bulging of the c5-5 disc, causing compression on ventral aspect of the calsac

- mild central posterior protusion of the of the C6-7 disc with slight indentation on the ventral aspect of the calsac

The cervical spinal cord is normal in size, shape and signal intensities. No definate nerve roots compression evident. No abnormal bone marrow signal is seen

Can someone tell me what it means in real layman terms. The neurologist explained it isn't causing any problems now, but might be very serious in the future.

[PeaceBlondie]

The medical specialist should tell you. That's why you pay them the big baht.

[Preacher]

He told me that in time I could lose function of my arms and legs as there was severe erosion and my spinal cord could be exposed in the future. But he was weak in telling what I should do to minimize the risks. I will see a rehabilitation doctor about that, but in two weeks.

[alfieconn]

He told me that in time I could lose function of my arms and legs as there was severe erosion and my spinal cord could be exposed in the future. But he was weak in telling what I should do to minimize the risks. I will see a rehabilitation doctor about that, but in two weeks.

Something as serious as this i think i would go back to the UK for a second opinion.

[PeaceBlondie]

Good luck - ask questions.

[waza]

very basically its saying the disc between the bones in your neck, vertabra, are out of shape and if it gets worse it will press on the nerves that exit from the area disrupting the movement signals from your brain to your arms. the c4,5,6,7 nerves supply the motor function for all of your arms, how this will effect your legs i have no idea

Edited March 3, 2010 by waza

[FBN]

One should not treat just the MRI results alone; there are spinal changes with age, previous injuries etc etc.

Why was this done in the first place?

[waza]

He told me that in time I could lose function of my arms and legs as there was severe erosion and my spinal cord could be exposed in the future. But he was weak in telling what I should do to minimize the risks. I will see a rehabilitation doctor about that, but in two weeks.

haha love the exposed spinal cord bit, that will never happen

[chiang mai]

The Moderator Sheryl will almost certainly be able to explain your report to you since she is a nurse, I suggest you perhaps contact her? My very limited experience of these things is that you potentially have one or two bulging discs, it seems to be fairly prevalent in older people and people with bad posture - I've had a spinal MRI done over fifteen years ago as a result of having two prolapsed (bulging) discs, both of which were satisfactorily treated using a Chiropractor so I wouldn't be overly concerned.

[Preacher]

One should not treat just the MRI results alone; there are spinal changes with age, previous injuries etc etc.

Why was this done in the first place?

I'm 43 years old.

The scan was done because of complaints of neck, shoulders and arms. probably a-specific RSI. But some time ago a doctor thought it might be a thoracic outlet syndrome. Another doctor said no way. Te MRI was done to rule that out and showed an old injury as a result. Probably caused by an accident at school during gym when i was about 14. Hit the ground with some speed on sling.

[richard_smith237]

It appears as though you have been suffering some ruptured / herniated discs.

These discs are the cushioning between your vertebrae. The herniated disks appear to have bulged out and could be pressing against your spinal cord causing some nerve interference.

Solutions are:

1) Be very careful and reduce your activities that could cause stress or strain on your body.

In Extreme cases:

2) Fusing your vertebrae together. This removes movement between the damaged vertebrae.

3) Disc replacement - Less successful and perhaps still in its experimental stages.

Edited March 3, 2010 by richard_smith237

[FBN]

I'm 43 years old.

The scan was done because of complaints of neck, shoulders and arms. probably a-specific RSI. But some time ago a doctor thought it might be a thoracic outlet syndrome. Another doctor said no way. Te MRI was done to rule that out and showed an old injury as a result. Probably caused by an accident at school during gym when i was about 14. Hit the ground with some speed on sling.

Try and relate the pain to the areas on the upper arm and back supplied by the nerves from these sections (you can search "dermatomes). C3/4 Shoulder top; C4,5 upper arm, C5,6 elbow and front of arm. Only below C7 will it affect the upper back (sensation only; not due to muscle spasm).

Unless you have pins and needles in these areas which may result in secondary neck muscle spasm which will then affect the upper back; it is quite possible that the findings relate to old injuries. best not to have anybody manipulate the neck. A neck brace at times and gentle traction by a physio with a halter traction device may also help.

Avoid surgery as long as possible. if you fuse 2 levels, the level above and below has to compensate for movement lost and this results in increased wear and tear which becomes a viscious circle.

[chiang mai]

There's a difference between a bulging disc and one that's ruptured, I'm sure that if one of the OP's disc's had ruptured he would have been so advised. As mentioned earlier I was diagnosed with bulging discs and was in horrendous pain for many weeks, the recommendation at the time was to have a disectomy (fusing two vertebrae together) and I came within three days of the operation before visiting a Chiropractor friend - the result was that I did not need the operation and I have had very few problems ever since.

[Preacher]

Many thanks for the advises so far. It is much appreciated and helps me to understand a little better.

I thought the pain was related to RSI or CANS as they now sometimes seem to call it, but it seems it might be this old injury. Seems more serious than i thought.

[chakatee]

the calsac = thecal sac actually

indentation on the ventral aspect of thecal sac = the bulging disc which is pushing at ventral (=abdominal) side of spinal cord and surrounding fluid.

So what is described can explain your symptoms.

And ignore the comments about a chiropractor please. We are talking about C-spine here, not L-spine. You would want someone to clean your teeth with a crane right? Have your C-spine treated with 'gentle care' (well dosed, machinally, traction maybe), not manually pulled, twisted, ... by man force.

[Macx]

Get second and third opinions. Maybe even another set of MRI at another place.

Happened to me here. Lousy MRI (old machine and incompetent tech at an "international hospital") followed by lousy radiologist and then a lousy doc. Recommendation: immediate surgery. Total cost 15k+. Got a second opinion and a second set of MRI from another place. Years later, the second opinion have been proven right.

Don't panic. Best wishes.

[chiang mai]

When considering spinal surgery versus its alternatives, always remember that you cannot un-operate hence fully exploring options and alternatives is highly recommended. Goof luck with what ever you decide.

[Sheryl]

you do not have any herniated disks. You have some bulging (prolapse) of 4 disks, 3 of these mild, 1 more severe and that one (at C5, i.e. the 5th cerviocal vertebra) is causing some compression on the membrane which surrounds the spinal cord (thecal ssac).

If this worsens it could compress the spinal cord itself in which case, if the compression is not quickly relieved, permanent damage could occur resulting in paralysis of areas supplied by nerves below that point. This is the risk the doctor was speaking of. At the moment the spinal cord itself is fine so you are not in an urgent situation.

How much risk there is of the disk protrusions worsening to the point of spinal chord compression I cannot say.

The other thing I cannot say is if in fact any of your symptoms are due to this, but it appears to me -- as a non-specialist in this area -- that they may not be since there is neither nerve root nor spinal cord compression. It is not at all uncommon for people to have eroded or prolapsed disc with no symptoms whatsoever, and also not uncommon for symptoms to be wrongly ascribed to disk problems which are in fact incidental findings.

MRIs are good for visualization of soft tissue but not of bone. You could have some bione spurs compressing nerves that would show only on an Xray. You could also simply have a RSI as you originally thought.

If an Xray was not done, it should be.

There are special nerve conduction tests that can be done to determine exactly where pain is originating from, should always be done before undergoing spinal surgery to avoid the risk of repairing something that wasn't in fact the cause of the pain.

In short you need to know 2 things:

1. Whether or not there is a serious risk of future cord compression and if so what should be done to minimize these. No one will be able to guarantee no risk, but what you want is a % risk based on your particular findings.

2. Whether or not the pain you are experiencing is due to these findings or something else and if so, what and what to do about it.

I strongly recommend you take your MRI film (not the report, the actual films) and any other test results to Dr Wicharn at BNH Hospital. He is excellent and I have more than once seen him correct other doctor's misinterpretations.

Do not under any circumstances allow anyone to manipulate your neck or upper back. Massage of muscles is OK but no manipulation of bone.

[zaphodbeeblebrox]

As a lawyer, I reviewed thousands of spinal MRIs with orthopedic and neurosurgical doctors. I have some similar cervical findings as you, and have also sometimes suffered from postural carpal tunnel syndrome (due to too much computer work in a non-ergonomic environment).

If you are able to withstand the pain and are not experiencing severe numbness or "pins and needles" radiating into the fingers of your hand, you can improve your symptomology by undergoing physical therapy and an exercise program. If you haven't done this before, you should consult with a physiatrist or a physical therapist who you can trust. You need to strengthen your neck and shoulders, but you have to work your way slowly through an exercise regime. If your pain is acute, you would start with physical therapy, including electrical stimulation and ultrasound. You can also purchase a TENS unit, which is like a walkman for electrical stimulation. Physical exercise should start with passive (no weights) stretching and range of motion exercises for your neck, shoulders and arms. At some point, you can begin to incorporate weight-resistance exercises into your routine. Shoulder shrugs, triceps extensions and lat-pull downs are good resistance exercises which will build up the muscles, and provide support to your cervical spine. You can use NSAIDs (non-steroidal anti-inflammatory drugs) like aleve (naprosyn) to relieve bouts of swelling and pain in your neck and arms. NSAIDs are not recommended if you have an underlying cardiac condition.

If the pain gets unbearable, then you should consider surgical options, which usually include a diskectomy and fusion. I would only do that as a last resort, but it's a personal health decision.

Edited March 4, 2010 by zaphodbeeblebrox

[Who, me ?]

you do not have any herniated disks. You have some bulging (prolapse) of 4 disks, 3 of these mild, 1 more severe and that one (at C5, i.e. the 5th cerviocal vertebra) is causing some compression on the membrane which surrounds the spinal cord (thecal ssac).

If this worsens it could compress the spinal cord itself in which case, if the compression is not quickly relieved, permanent damage could occur resulting in paralysis of areas supplied by nerves below that point. This is the risk the doctor was speaking of. At the moment the spinal cord itself is fine so you are not in an urgent situation.

How much risk there is of the disk protrusions worsening to the point of spinal chord compression I cannot say.

The other thing I cannot say is if in fact any of your symptoms are due to this, but it appears to me -- as a non-specialist in this area -- that they may not be since there is neither nerve root nor spinal cord compression. It is not at all uncommon for people to have eroded or prolapsed disc with no symptoms whatsoever, and also not uncommon for symptoms to be wrongly ascribed to disk problems which are in fact incidental findings.

MRIs are good for visualization of soft tissue but not of bone. You could have some bione spurs compressing nerves that would show only on an Xray. You could also simply have a RSI as you originally thought.

If an Xray was not done, it should be.

There are special nerve conduction tests that can be done to determine exactly where spine is originating from, should always be done before undergoing spinal surgery to avoid the risk of repairing something that wasn't in fact the cause of the pain.

In short you need to know 2 things:

1. Whether or not there is a serious risk of future cord compression and if so what should be done to minimize these. No one will be able to guarantee no risk, but what you want is a % risk based on your particular findings.

2. Whether or not the pain you are experiencing is due to these findings or something else and if so, what and what to do about it.

I strongly recommend you take your MRI film (not the report, the actual films) and any other test results to Dr Wicharn at BNH Hospital. He is excellent and I have more than once seen him correct other doctor's misinterpretations.

Do not under any circumstances allow anyone to manipulate your neck or upper back. Massage of muscles is OK but no manipulation of bone.

Dr Wicharn, yes he is the Man. You also can meet Dr Eakpatipan if Dr Wicharn is not available. They work together, and make wonders !

[Preacher]

Thanks all again for the replies, it is a great help.

I think Sheryl got it right. The neurologist doesn't think my current problems are being caused by my old injury, but he was very worried it will in the future. He was amazed at level of the erosion, definitely not normal for someone my age.

A x-ray was done a year and a half ago, but of the thorax to rule out a thoracic outlet syndrome. No abnormalities where found. But maybe having one done of the cervical spine might be in order.

Good advise about BNH. I will see the rehabilitation doctor in two weeks at Maharaj (Suan Dok) Hospital in Chiang Mai and perhaps after that get a consult at BNH.

I really need to exercise more, that was also recommended in the past because of my complaints. I tried doing aerobics, but the pain from the neck and shoulder was not getting better. Rather is was worsening and not getting better after a few months. So I stopped. Might indeed not have been the right exercise and will ask the doctor about that.

I seem to have very narrow veins, also not helping.

[Sheryl]

Yes, need to have an Xray of the cervical spine to make sure there are no bone spurs that might be impinging on the nerves.

Another possibility is that it does sometimes happen that carpal tunnel or other compression syndromes , in addition to causing pain or numbness in the hands, will cause pain to radiate up the arm to shoulder and even neck. Which can make for a very confusing picture especially if the patient also has some spinal findings on MRI. Not usual, but I have seen it occur, with the neck and shoulder pain relived after release of the compression.

My original post had a typo, meant to say nerve conduction tests that can tell exactly where (in terms of nerves) the pain is arising from. They can do them at BNH. May help determine whether the disk problems or anything else that crops up on Xray is the culprit or not. Can also determine if there is any carpal tunnel or other compression and if so how bad. (You may need to specifically ask for that tho as the spine specialists and hand specialists are different folks and specialists tend to have tunnel vision).

I tend to doubt that the degenerative disk changes could explain your symptoms from what the MRI says but I am not an orthopedic surgeon let alone a specialist in spinal surgery.

Dr Wicharn will definitely be able to advise on this, arrange for nerve studies if indicated and also may have some thoughts/insights into my this degree of degenerative change at your age.

[Preacher]

Went to see the rehabilitation doctor this week. He said that my spine was normal for someone my age and I had nothing to worry about. Given the differences in opinion I will go and see doctor Wicharn. Better safe than sorry.

The rest is seems to be minor. he gave me some exercises for my neck muscles and a neck collar. If it doesn't help he told me to consider traction on the neck.

The pain in the right arm is caused by a beginning carpal tunnel syndrome. It seem the middle nerve in my arm is irritated or something. This can be prevented from becoming more serious and should heal if a take precautions.

The other nice thing was that my wife is a civil servant and we could use Maharat hospital and didn't have to use the Special medical Service Centre, which is the private part of the hopsital. The charge was thus only 50 baht for the doctor and 140 baht for the collar.