I’D APPRECIATE ANY AND ALL ADVICE AND INTERPRETATION OF MY MRI RESULTS, AS THE DOCTOR WHO SCHEDULED THEM, WON’T TALK ME UNTIL A MONTH FROM NOW.
I saw my spine doctor again on Thursday of last week (my first appointment with him having been in September) and told him I was still having a lot of neck trouble, and he prescribed me Flexeril and told me to schedule another MRI, which I did immediately for the very next day, and scheduled a followup with him for early this week to discuss the results with him.
After I left his office, his secretary called and said the doctor didn’t want to see me for a month, to see how the flexeril worked and won’t return my calls.
I’ve obtained a copy of my MRI from Friday and reading it am alarmed, and LOOKING FOR ANY ADVICE OR OPINIONS.
I’m a 40 year old male
I’m special agent for a federal alphabet soup agency, spend lots of time at the PC as well as wearing a bulletproof vest, and doing warrant services in the field, sitting in the car for hours on surveillance..
I’ve always been Mr Fitness. Since age 15, I’ve been constantly out running or working out in the gym religiously.
I’ve never had any traumatic injury to my neck, have never been in a car accident etc..
Starting in 2003, I would have a lock-up or crick in my neck once or twice a year, that a chiropractor could fix in a visit or two, usually resulting from sleeping wrong , but twice I remember from doing over- head tricep extension with cables.
In late 2009, I had an episode of chronic trapezius tightness for a month or more, that resolves itself with chiro and massage.
In mid 2011, I began to get neck fatigue, light burning sensation etc. where my head felt so heavy, I felt like I needed to prop it up with my hands, and I can’t seem to get comfortable anywhere, even sitting on the couch is unconfortable and makes my neck ache.
A month ago, I was washing my hair in the shower and my neck locked-up again and the chiro visits began again. I feel better after the chiro for the day, and feel great after an hour long massage session, for the rest of the day, but then back to the stiffness and fatigue the next day. While this was at it’s worst, I had moderate pain right at the bump on the back of my neck, but this has gone away.
Last week I had a chiro visit in the morning and then massage in the afternoon, and after the massage, my right arm felt funny/numb and that persisted till I went to bed.
My symptoms are chronically tight traps and stiff neck now. The doctor does have me on Flexeril for the last 4 days, and I do feel better, feel good when I roll out of bed, but the neck starts getting stiff as soon as I get to moving around. A hot shower helps loosen it up, but over the course of the day, it will get stiff again.
I believe working on the computer through the course of the day aggravates it.
Here’s what I have done:
-Changed my chair at the office, got a big monitor and positioned myself at eye level with the center of the screen, a keyboard tray so my arms rest on the chair’s armrest when typing
-Orthopaedic pillow, combined with a towel roll per docs directions
-New high-quality bed
-Icing with a coldpack for 20 mins 2x a night
-Going back to the gym after steering clear for 2 months, doing very light range of motion exercises and elliptical machine for cardio
I HAD AN MRI IN SEPTEMBER WITH THE FOLLOWING RESULTS:
C3-4 Very minimal disc bulge without neural encroachment
C4-5 Minimal disc bulge without neural encroachment. Minimal right neural foraminal narrowing
C5-6 Minimal disk bulge without neural encroachement. Minimal right neural foraminal narrowing
C6-7 There is minimal disc bulge. There may be a tiny middling annular tear without neural encroachment
FRIDAY I HAD ANOTHER MRI AND THE RESULTS LOOK DRAMATICALLY DIFFERENT AND WORSE!
C2-C3 No significant disc bulge or protrusion visualized, No evidence of neural encroachment
C3-C4 Minimal disc dessication and disc bulge without significant neural encroachment
C4-C5 Disc mildly dessicated with loss of disc heights. There is a small, broad based right paracentral disc protrusion that does efface the thecal sac anteriorly and partially extends into the right neural foramina, resulting in moderate right foraminal narrowing. This is more conspicuous when compared to previous exam.
C5-C6 The disc is moderately dessicated with loss of disc height. There is a broad-based right paracentral disc protrusion that effaces the thecal sac anteriorly. There is mild central canal stenosis with AP dimension of the thecal sac measuring 9mm. The disc protrusion may have a small overlying osteophyte and does result in moderate narrowing of the right neural foramina. This is more conspicuous with compared the previous exa,m.
C6-C7 The disc is mildly dessicated. There is a broad based left paracentral disc protrusion with small annular tear that does efface the thecal sac anteriorly. No central canal stenosis is present. There is very mild narrowing of the left neural foramina.
Reading on the net, some of the results on this MRI scare me!
Stenosis, osteophyte etc..?Everything looked ok 4 months ago!
How could my neck have gotten so much worse in 4 months?
Can I turn any of this degeneration around and lead an active, healthy life, or am I doomed to be a cripple by retirement age or earlier?
Do others with similar conditions have a turn for the better?
I can help you with the terminology used in the reading of the MRI.
But, before I start with what the words mean, you have to note that when the radiologist reads most of these findings, they are listed as "very mild, mild, minimal, and a few moderates". Also, the reading of MRIs is very subjective. What one radiologist reads as mild, another may read as normal. Or, it could be the other way, one reads it as mild, another may read it is moderate. So, if you have the study read by 10 different radiologists, you will get 10 different readings.
Comparing it to the previous study is the best way to look at it, just like the radiologist did. But, again, how much is changed is very subjective.
So, though you do have some finding, in the overall big picture, they are not that terrible. That said...
"C2-C3 No significant disc bulge or protrusion visualized, No evidence of neural encroachment"
>> This level is "normal"
"C3-C4 Minimal disc dessication and disc bulge without significant neural encroachment"
>> The very early signs of degenerative disc disease (DDD) are disc dessication, or the loss of water from the annular fibrosus. The annulus is the cartilage ring part of the disc complex. When it undergoes the early stages of DDD it begins to lose water (desiccates, or starts to dehydrated) and it bulges out radially. Just like an underinflated tire.
However, a note about disc bulges. Mild to moderate disc bulges can be seen on MRI, in up to 40% of asymptomatic spines (people who have no spine problems or pain). So, just because there are disc bulges, it does not mean that they are the source of any problems. They may be, but they also may not be. Just a note on disc bulges.
So, at this level, you have the very beginnings of DDD. The disc shows minimal drying out. The radial bulge in the disc does NOT touch or come close (encroach) to any of the neural structures, such as the spinal cord or nerve roots.
"C4-C5 Disc mildly dessicated with loss of disc heights. There is a small, broad based right paracentral disc protrusion that does efface the thecal sac anteriorly and partially extends into the right neural foramina, resulting in moderate right foraminal narrowing. This is more conspicuous when compared to previous exam."
>> Again, the disc is dried out a little. The loss of height in the disc goes along with the radial bulging. Again, just like a tire that is underinflated.
Here, along with the radial bulging, there is a small area that is bulging (or protruding) a little more on the right side of the back of the disc. Here, this protrusion does touch (efface) the thecal sac. The thecal sac is the thick sheath that goes around the spinal cord and brain. It holds in the CSF (cerebrospinal fluid). But, the spinal cord inside is not being touched.
This protrusion also goes into the right neural foramina. Foramina just means "hole". The neural foramen is the hole through which the nerve root exits the spinal canal. This causes some narrowing (also called stenosis) of the hole. It is more than on the previous study. But, it does NOT touch or press on the nerve root going through the hole.
"C5-C6 The disc is moderately dessicated with loss of disc height. There is a broad-based right paracentral disc protrusion that effaces the thecal sac anteriorly. There is mild central canal stenosis with AP dimension of the thecal sac measuring 9mm. The disc protrusion may have a small overlying osteophyte and does result in moderate narrowing of the right neural foramina. This is more conspicuous with compared the previous exa,m."
>> This disc is probably the most involved. The disc has moderate DDD. Same as above, just a little bit more.
But, here the disc bulge narrows the spinal canal to about 9mm. This is spinal stenosis. Stenosis just means "narrowing". Normally, the AP (anterior-posterior or front to back) diameter of the C spine is 10-20mm, depending upon where along the cervical spine the measurement is taken. Higher up it is larger (C1 - 20mm), lower down it is smaller (C4 and below - 10mm). So, at the C5-6 level, a measurement of 9mm is just barely considered stenosis.
There is a small bone spur (osteophyte) that also contributes to the narrowing of the right neural foramina. Again, more than the last study. But, again, it is NOT touching or pressing on the nerve root.
"C6-C7 The disc is mildly dessicated. There is a broad based left paracentral disc protrusion with small annular tear that does efface the thecal sac anteriorly. No central canal stenosis is present. There is very mild narrowing of the left neural foramina.
>> Same DDD of the disc. But, the stenosis noted at the above level is no longer present. Here, the left neural foramen is very mildly narrowed.
This disc does show a small tear in the annulus. Remember, that is the cartilage ring of the disc complex. However, the nucleus pulposus is still intact. The nucleus is the jelly like center of the disc complex. When there is a herniation, some of the nucleus squirts out through the annular tear and may impinge on a nerve root. This is a "herniated disc". But, you do NOT have this.
So, overall, you have some mild to moderate DDD, manifested by early disc dessication and bulges. At one level, you have mild central spinal canal stenosis. At a couple of levels you have some mild narrowing of the neural foramina, without root impingement. One level the narrowing is considered moderate. You have a small annular tear, without any herniation of the nucleus.
So, overall, yes, you have some findings, which could be causing your symptoms. But, all findings on any study have to be correlated with the patient's history, symptoms, and physical examination.
I have seen some studies that looked absolutely horrible, yet the patient had minimal symptoms. And, also the reverse; where the study did not look that bad, but the patient was almost an invalid. Which is why surgeons are always taught, you treat the patient, not the study. We do not operate on x-rays or MRIs, we operate on patients.
As to the significance of these findings, that you will have to discuss with your physician. No one tell you if they are significant, without examining you.
Thank you so much Gaelic for the throrough and lengthy reply....VERY much appreciated.
My muscles seem to be more relaxed while taking the Flexeril night (and day) in 10 mg doses (one before bed, one in the morning) but still get a stiff neck (particularly on the right side) after getting out of bed.
The stiffness sometimes improves through the course of the day, sometimes not.
I also get fatigue (heavy head) feeling and light burning in my traps during the day, that comes and goes as well.
I am getting massages twice a week or so as well to loosed these muscles up.
I don't have any pain on my spine anymore, and at least since Sunday, no more numbness in my right arm, just the muscles getting tense.
Since the Dr doesn't want to see me for a month, do you have any suggestions on how to deal with the neck tightness?
Gaelic, i just wanted to say thank you again for the extremely detailed reply to my findings and thankyou for breaking that down for me.
I really can't thank you enough..i know you put a lot of time into your reply, simply out of the goodness of your heart..
It's too bad my own doctor wouldn't when i tried to get him to explain my mri results to me..
All he would tell me is that "your mri results don't correllate with the symptoms you're having"..
My thought was that he was thinking, "see you next month.... patient please...".
Like my new, very gentle chiropractor, who also broke down the findings for me last visit said..."one thing is for certain, you won't have THIS pain forever...it's going to get better...or worse". You can look at this statement as positive or negative...i'm trying to think positive and that my situation will improve..
Ok...the Spine Dr actually just returned my call from a few days ago and we talked about my MRI results.
He asked if I'd like to try neurontin to deaden the pain.
I told him my "arm going to sleep" issue has resolved itself and I no longer have pain over my spine anymore where it originated.
I told him that the main issue that is causing me so much torment is chronically tight neck and trapezius muscles...just aching/burning all the time, making life miserable enough that I don't even want to leave the house..
And he said: "that is something muscular in nature and has nothing to do with what I see on your MRI"..
As a side note, today i was driving home (neck stiff as usual) and then like someone flipped a switch, the neck all of a sudden felt great, the pain stopped etc...but now i have had a slight pressure on my chest all evening, kind of like a chest cold where it's hard to get a deep breath. Related?
Edit. About 7pm tonight (now 11pm) my right arm started going to sleep and the chest pressure is gone, but the arm numbness remains..
Sorry about not getting back to you, my spouse was in the ICU for a couple of days.
The fact that you have some mild DDD in the cervical spine, this may be causing some discomfort, which makes you tense up, causing the muscle tightness.
Actually the best thing for this is massage therapy. The muscle relaxants actually do not have any pharmological action on skeletal muscle. They are just very sedating. So, if some patients get to sleep and relax, their muscle pain subsides.
But, massage will usually actually help to get the muscle to relax. You can also use hot packs or a hot tub to help.
The chest pain is most likely not coming from your neck. As you know, if you continue to have chest pain, accompanied by sweating, radiating pain to left arm or neck, you need to be evaluated for a cardiac event. Or, it could be tightness from a pulmonary problem.
The right arm pain can be coming from a lot of things. Even the muscle tightness. Thoracic outlet syndrome or a brachial plexus problem, or even a peripheral nerve problem could be causing it. It would take a thorough examination to determine what nerve(s) is being compressed to cause the numbness and where.
From the MRI, there are no nerve roots being compressed. But, again, it would take an exam.
If the numbness does not start to do away, you may need to have it examined.
Many thanks for your reply and i hope everything is ok with your spouse. My father went in for tests for chest pain tuesday and they opened him up for a triple bypass wednesday, but he seems to be recovering well.
I've had both left and right hand numbness since i last wrote , and my left foot for a few hours yesterday..
The chest pressure has not returned.
I'm pretty stressed about the numbness turning into something worse that will cause me to have to medically retire from my dream job..
Wish me luck...
Thanks again or your wonderful and informative replies..
Kevlar hope you are better. If you continue to have problems you might want to talk to your Dr. about dystonia. I have cervical dystonia and sounds a lot like your symptoms. I see a neurologist in a movement disorder clinic. But again I hope that you are doing great.
Wish I had someone to interpret an CT that I just had done. He is amazing.