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Neurology (Expert Forum)
herniated discs
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herniated discs
by Galindo, Jan 12, 2005 12:00AM
I had mri and the report says the following: "Exam performed: MR CERV SP W/O.History: Evaluate for herniated disc. Findings: Sagittal images show the aligment of cervical spine to be normal aligment.Evaluation of cervical spine vertebral bodies demonstrates endplates degenerative changes at the c4-5 and c5-6 levels.Evaluation of the intervertebral disks demonstrate loss of signal within the discs thoughout the bowel degenerative change.The visulized cervical spinal ccord demonstrates a questionable area of increased T2 signal at the c6 level on inversion recovery images only.This is not seen on any other image sequence and may reflect an artifact. A tiny area of abnormal T2 signal cannot absolutely excluded.Evaluation of the c2-3,c3-4,c4-5 levels demonstate a mild generalized disc bulges and osteophyte with small left paracentral disk protrusions.Findings efface the anterior thecal sac but do not impinge on the spinal cord.The neural foramina are open.Evaluation of c5-6 level demonstrates a generalized disc bulge and osteophyte with superimposed right paracentral disk protusion and ostephyte.Findings efface the anterior thecal sac and cause cord compression.There is moderate neuroforaminal narrowing secondary to uncovertbral joint hypertrophy.Evaluations of the c6-7,c7-T1 level demonstrates no focal abnormality." I saw a neurosurgeon because of the above findings and he said that I am not candidate for operation at this time evethough I have classic symptoms of numbness,weakness in my arms,hands,fingers,legs from knees town,bottom of feet and also pain at the back of neck(less now than before),heaviness at the back of neck most of time,twitching in arms,legs,abdomen etc. 1.What would "Evaluation of intervertebral disks demonstrates loss of signal within disks throughtout the bowel degenerative change" mean on MRI report and does "bowel degenerative change" suggest loss of bowel and bladder function?If no what does it mean? 2. What does "visualized cervical spinal cord demonstrates a questionable area of increased T2 signal at c6 level on inversion recovery images only.This is not seen on any other image sequence and may reflect an artifact" suggest if it is not artifact and in your opinion do I need another test or MRI because of this finding? 3.At c5-6 what does "Findings efface the anterior thecal sac and cause cord compression" means and does it look serious by the way it is written,because I heard that when there is cord compression operation is indicated immidiately(ER)? 4. About 6 months ago(prior to the above MRI) I had another MRI at the different hospital and on that report says"At the c5/6 level,there is mild posterior cord displacement secondary to circumferential disc bulging and spuring.There is also mild bilateral foraminal narrowing secondary to spuring." What does above mean and does it mean that there is a disk herniation at c5-6? 5. At c2-3,c3-4,c4-5 on last MRI do I have herniated disks and will this small disk protrusions became large in near future?6.Well I know operation is indicated when there is weakness,numbness,loss of bowel and bladder function,but what kind of weakness and numbness:total,partial,when I can't move arm or leg,1,2,5 pounds and does loss of bowel and bladder function means total numbness in the private areas and are there any warning signs?Thank you
Doctor's Answer
by CCF-Neuro-M.D.-CS, Jan 12, 2005 12:00AM
1) bowel degenerative change sounds like a typo and does not make sense. It certainly does not pertain to bowel or bladder function
loss of signal within discs is usually normal in older age due to loss of water content (see my answer to 'dessicated discs' earlier this month
2) on MRI the spinal cord can appear to be compressed from teh outside but if there is a bright spot within the spinal cord, the compression is more severe and signifies damage. This may or may not be the case withyour MRI as they say the finding is 'quesitonable' - it must be a minor finding - I cannot say without seeing your MRI. Usually neurosurgeons can tell if this is real or not. A repeat MRI now would not be useful if the one you had was of good quality.
3) varying degrees of cord compression can be seen on MRI, some significant, some not - I cannot tell without seeing your MRI. If you still in doubt whether you need urgent treatment, contact your neurosurgeon.
4) This means that the disc which usually bulges backwards when it is displaced is pushing the spinal cord back, (but does not sound like it is compressing it). The nerves that exit from the spinal cord go through bony canals or foramina before going down the leg, and it sounds like these are narrowed from arthritis (spurs) or degenerative change (usually due to age/wear and tear). This can cause symptoms also in the legs.
5) bowel and bladder dysfunction from a spinal cord problem usually comes togther with motor dysfunction ie weakness and increased reflexes in the legs, than sensory complaints, as these fibers run together in the spinal cord. There is no definite cutoff for surgery. Surgery has its own risks and does not gaurantee a resolution of your back problem. Maybe you should get a second opinion from another neurosurgeon - unfortunately I cannot be more specific in your case
Good luck
loss of signal within discs is usually normal in older age due to loss of water content (see my answer to 'dessicated discs' earlier this month
2) on MRI the spinal cord can appear to be compressed from teh outside but if there is a bright spot within the spinal cord, the compression is more severe and signifies damage. This may or may not be the case withyour MRI as they say the finding is 'quesitonable' - it must be a minor finding - I cannot say without seeing your MRI. Usually neurosurgeons can tell if this is real or not. A repeat MRI now would not be useful if the one you had was of good quality.
3) varying degrees of cord compression can be seen on MRI, some significant, some not - I cannot tell without seeing your MRI. If you still in doubt whether you need urgent treatment, contact your neurosurgeon.
4) This means that the disc which usually bulges backwards when it is displaced is pushing the spinal cord back, (but does not sound like it is compressing it). The nerves that exit from the spinal cord go through bony canals or foramina before going down the leg, and it sounds like these are narrowed from arthritis (spurs) or degenerative change (usually due to age/wear and tear). This can cause symptoms also in the legs.
5) bowel and bladder dysfunction from a spinal cord problem usually comes togther with motor dysfunction ie weakness and increased reflexes in the legs, than sensory complaints, as these fibers run together in the spinal cord. There is no definite cutoff for surgery. Surgery has its own risks and does not gaurantee a resolution of your back problem. Maybe you should get a second opinion from another neurosurgeon - unfortunately I cannot be more specific in your case
Good luck
Member Comments (5)
by Galindo, Jan 13, 2005 12:00AM
Thank you Dr. for answering my questions,but I have few follow up questions. 1. Do auto rear end accidents cause at c5/6 level mild posterior cord displacement secondary to disc bulging and spuring as well as generalized bulge osteophyte with small left paracentral disc protrusion and osteophyte at c3/4? If they do cause how long after auto accident usually the above conditions show up on MRI? 2. In your answear to number 4 question you wrote "This means that the disc which usually bulges backward when is displaced is pushing the spinal cord back(but does not sound like it is compressing it)" Do you mean by the above that spinal cord at c5/6 level instead of being pushed and compressed (in the wrong direction) it is being pushed naturally backward to its normal position? 3.Usually what symptoms does mild posterior displacement of cord at c5/6 level causes(and would twiching be one of symptoms) 4.I am not doctor but by reading the first MRI report,which is 6 months old,it saunds like there is bulging and no herniation of disc at c5/6 level,however reading the second MRI report of c5/6 disc sounds like there is (protrusion) herniated disc.Do you agree? 5.In your opinion what exercises will make the above cervical spine conditions better and worse?Thank you
by smoothschool101, Jan 14, 2005 12:00AM
i recently had a fussion on my lower back. my question for anyone with the same for some advice on nerve damage? i fell off of a ladder about 7ft. they fused l4/l5/s1 toigether with rods aND a bone graft . i have no feeling or very little in my right foot and outer calf area. i'm wondering if anyone has similar symptoms and whether it will come back?i also have loss of muscle in both legs predominataly in my right leg ang what would be the way to rebuild strenght? this is aworkers comp. injury and i am 33 years old ,what is the average settelment for somone my age with this condition ,because i may not be able to do my job any more? i'd appreciate any advice, thank you.
by Billy!, Jan 16, 2005 12:00AM
Auto (rear-end) accidents do cause dics herniations,especially at c5-6 level because I had one 5 years ago.At first I was diagnosed with sprain later to be changed to disc herniation at c5-6.I had surgery and I am feeling fine now?Hope this helps you.Billy
by weeeeeble