Kink in Spinal Cord, Focal Kyphosis, Stenosis, Disc Protrusion, DDD -HELP!!

Ok, now that I have spent $15 to post a question here, I can NOT get the info I need to post narrowed down to the ‘2000’ character limit. SO, I am going to try & post my MRI results & questions in 2 or 3 (if needed) separate posts. PLEASE read ALL (if it works even!!) and then reply.

I will start with only the "ABNORMAL" parts of my MRI results. All were done without contrast.

CERVICAL

There is straightening of normal lordotic curvature.

C3-4: There is a small posterior disc osteophyte complex. The spinal canal is mildly narrowed to 8mm. There is mild narrowing of the bilateral neural foramina secondary to uncovertebral osteophtyes, slightly more prominent on the left.

C4-5: Small broad posterior disc osteophyte complex is present, which narrows the spinal canal to 8mm. There is mild narrowing of the bilateral neural foramina secondary to uncovertebral osteophtyes. Mild right neural foraminal narrowing is present.

C5-6: Small broad posterior disc osteophyte complex is present, which narrows the spinal canal to 8mm. There is moderate-to-severe left neural foraminal stenosis uncovertebral osteophtyes. Mild right neural foraminal narrowing is present.

C6-7: Small posterior disc bulge is present. The spinal canal is mildly narrowed to 8mm. There is mild-to-moderate left neural foraminal narrowing. The right neural foramen remain normal caliber.

Congenitally short pedicles contribute to multiple levels of spinal canal stenosis as described above.

(message continued in next post)

[Stephen Ryu, MD]

That was a long post and I tend to notice that the longer the post, the less likely there is a surgical answer to the question. I would have to say as a preface that I do agree with Greg Miller's words of encouragement to never give up hope and don't let your mind fail you! I spend a lot of time explaining to patients in clinic that there is nothing surgical that can be done for them - this upsets some people, but I try to get them to understand taht surgery can make you a lot worse and not address the issue. There are limits to medical science. Most people I see can be helped; but not all. Expectation management is very important as well. Some people expect to be pain free and will accept no less - this will never happen for most of them. So it sort of sets them up for a life cycle of pain and depression. There is always HOPE that things will get better or science will get better.

Having said that .... Your C spine MRI sounds like you have a narrow spinal canal that you were born with - this will get worse with age and may or may not cause a problem. It might be causing a problem now, but I can't tell based on the report. The thoracic exam notes a couple discs that are small. The T7-8 disc might be causing a problem given the kyphosis, but can't tell for sure.  Lumbar spine changes are rather advanced. Overall, your scan reports show a lot of gerneral changes. You say that you are quite young.

It is unusual to have such advanced changes at your age unless you have been overweight and inactive most of your life. In such cases, I have seen very advanced degeneration but almost always there is nothing that can be done surgically as it is a global problem.

As your neck and back do not seem to be your biggest issues, the changes don't scream out that you need something done. Your thoracic scan is intersting, but hard to determine what is the exact problem. You seem to have an activity related component to your pain - I assume it gets better when you are not doing anything or taking a break. Often, patients are better on weekend when they don't work.

It would be unusual for these finding to cause any GI issues. Typically unless there is spinal cord compression, there is usually no GI issues. The GI tract has its own nervous system that travels down the chest and along the bowels that is controlled by different nerves that the ones in your spine. The heart and lungs and gut also are part of an autonomic (automatic) nervous system unlike the voluntary portions. Parts of this system does travel in the spine but I have never seen patients get operated on or better from GI/heart issues after spine surgery. Some chiropracators would argue otherwise, though, and say everything can be fixed from your spine.

Your family history of spinocerebellar degeneration is interesting. It is probably in addition to whatever spine issues you have. The instability and ataxia is weird and I don't think this is coming from your spine - probably from your brain.

If your problem was straightforward and not complicated with additional symptoms and complaints it might be easier to figure out what is causing what. I agree with most of your surgeons that surgery is a very last resort and I don't even know what surgery you would need at this point. Surgery is good for a clear abnormality.

Other methods of management are continued PT, pain management, and nonsurgical treatments. There are many people out there like you and you mustn't give up.

[PV92804]

(Continued from original post)

THORACIC:

There is a small Schmoral node involving the inferior endplate of T7. There is focal kyphosis of the thoracic spine centered at T7-8. At this level, there is a central disc protrusion/disc osteophyte complex measuring approximately 4mm in AP dimension. This causes moderate spinal stenosis with the AP dimension of the spinal canal measuring approximately 5-6 mm. The focal kyphosis causes a kink in the spinal cord. The disc does abut the ventral surface of the spinal cord at this level; no abnormal signal intensity of the spinal canal is seen.

At T6-7, there is a small, 2 mm right paracentral disc protrusion. There is no neural foramen narrowing or spinal canal stenosis. The AP dimension of the spinal canal measures approximately 8mm.

At T9-10, there is a 1 mm right paracentral disc protrusion without evidence of spinal stenosis or neural foramen narrowing.

LUMBAR

L5-S1: There is severe hypertrophic degenerative disease of the facet joints bilaterally.

L4-5: Broad posterior disc protrusion is present measuring 3-4mm. A periphery of abnormal signal intensity represents a small annular fissure. Moderate left foraminal stenosis is seen. There is mild-to-moderate right foraminal stenosis. The spinal canal is narrowed to 7mm. Small amount of CSF is maintained surrounding the nerve roots. There is severe hypertrophic degenerative disease of the bilateral facet joints, which contributes to the spinal canal stenosis. Additionally, there is moderate left lateral recess stenosis and mild right lateral stenosis.

L3-4: There is mild narrowing of the spinal canal to 8mm with CSF maintained surrounding the nerve roots. Sever bilateral hypertrophic degenerative disc disease of the facet joints is present, which contributes to the spinal canal stenosis.

L2-3: There is severe facet arthropathy.

L1-2:  There is severe facet arthropathy.

T12-L1: Minimal disc bulge is present.

Specific QUESTIONS:

- Can anyone give me a “clearer” explanation of the pain in my back, especially the Thoracic area? Likely cause, etc. (is it the kink in the cord, the focal kyphosis, none/all of the above?) Thoracic pain is aching, and at times sharp. Between scapula, & under back bra strap. Worsens with use of arms, and holding anything (like an infant) Also have large area of numbness in upper back around area of pain.  

- I have some pain off & on in the cervical & lumbar area (sharp mostly, aching at times), please address that also. Thoracic is definitely the worst though!

- What other treatments and or tests might be beneficial? Had epidural injection., TENS unit, muscle stimulator, P/T. Should I consider surgery? Only tests were the MRI's

- Based on the MRIs, it seems to me like I have a LOT going on in multiple areas of the spine. Is any of this ‘serious’? Will it truly 'just get worse' over time as I have been told?

- Can any of the above spine issues also cause GI or neurological issues (I have MS/ataxia symptoms & GERD w/regurgitation but no acid refulx?

I HAVE sought treatment with orthopedic, GI & neurologist MDs. Just not happy with the "deal with it - nothing can be done" answers I get. Hoping to find more insight & clarification of MRI results here. Seems there should be more that can be done.

THANK YOU!!

[PV92804]

Now that I know doing separate posts works, I will add more detail as I had originally planned. Maybe this will help offer more insight.

HISTORY:
I am a 39 year old female. I have had long standing upper back pain (about the level of my bra strap in the back, and in between my shoulder blades) I also have an area of decreased sensation (numbness) on the left side of that same area (mid back, left of spine, about shoulder blade level & lower, covering an area about the size of a large mans hand) I have occasional sharp pains in and around the spine in that area, but mainly the pain is an intense ‘ache’ of the upper back region. It increases with activity that involves using my arms, such as driving, folding laundry, washing dishes etc. I can barely tolerate anything that requires use of my arms and holding weight combined, such as holding an infant or child, even of newborn weight. I am not positive of when the pain started, possibly as much as 10 years or so ago, and do not know if it was caused by an injury at some point in my life. I was doing heavy lifting at work when the intensity & frequency of the pain increased by a lot. (I no longer do heavy lifting) Within the last 1-1.5 years it has significantly increased to where it is now a daily situation, especially if I am active (like cleaning house, cooking, driving etc.) I have also noticed (more recently) pain in the sternum area, mostly with a deep breath or certain movements. It is a sharp pain that radiates along the general sternum area, not just one specific spot on the sternum. (it is definitely in the middle of my ribs- cardiac causes have been rule out so far) I have occasional tingling on the bottom of my right foot, literally right down the middle of it.

TREATMENTS:
I have had 2 epidural injections in the T7-8 area, with no pain/symptom relief. I have tried a TENS unit & a muscle stimulator of some sort that was to relax the back muscles. Neither device offered me any relief, and in fact the TENS unit caused sharp pain where the nerves were being stimulated, even when on low intensity. It seems to have caused pain to shoot into my arms & legs also, along with tingling sensations. This tingling lasted for a few months, even after I discontinued using the units, so we do not know for sure if the units were the real cause of the tingling. The TENS unit definitely caused the nerve pain. Because of the ongoing tingling I was referred to a neurologist. (more info below) PT was also prescribed at some point, but the physical therapist said after my first evaluation that there was nothing she could do for me. The orthopedic surgeon said he did not feel I was a surgical candidate (in regards to my thoracic pain, which is what bothers me the most) unless at some point I was to become paralyzed. Since I would resist surgery until I was 100% sure all other options had been exhausted, I was ok with this. But really feel I deserve to know what my other options are, if any!!  

OTHER INFO:
I have had 4 years of GI problems. Main issue is regurgitation of food, without heartburn. Basically, after I eat, food will come back up into throat & sometime mouth, starting about 30 minutes after I eat & continuing for an hour or two afterwards. I am being followed by a GI, and have had upper endoscopy. They don’t know what is causing these symptoms. I only mention it here because I am wondering if it could be related to the trouble with my back in ANY WAY. I have read that sometimes problems with one’s spine can cause other systemic issues, like heart, GI etc. problems. I don’t know if this is true, and would like to know.

I was referred to a neurologist due to the tingling in my hands & feet that started after I began using the TENS unit. A nerve conduction study & EMG were essentially normal. The tingling improved after a few months, and all that I have now of it is the occasional tingling in the middle, bottom, of my right foot, as described above. I also have some neurological deficits, diagnosed within the past year. These include ocular dysmetria, inability to tandem walk & positive romburg sign. I seem to stumble easily & feel unbalanced often. The neurologist first suspected MS, based on the above and my history of tingling in hands/feet. A brain MRI was negative at the time. Currently he suspects mild, beginning ataxia, as my half brother & half sister on my mothers side BOTH have Spinocerebellar ataxia. They were symptomatic in their 30’s & diagnosed in their early 40’s. They are 20 & 16 years older than me, respectively. Again, I only mention this here as I am wondering if the above neurological symptoms could be related to the condition of my spine. I realize it may seem more like it will be MS or ataxia, but I would still like to know if there is much of a chance that these neuro findings could be related to the condition of my spine instead of being ataxia/MS signs.

Too much back trouble for a 39 year old, right? If it is going to ‘just get worse’ as the MD’s say since it is ‘degenerative’, I can only imagine when I am 80!

[Greg Miller]

Hey there:

I am right there with you!  I went to the doctor with chronic stabbing pain in my right side, bottom of rib cage level in back.   He X-rayed it and saw a huge bone spur (osteophyte) on the right side of my T`12 and moderate to severe degeneration of my T11 T12.  There is not spinal cord contact yet but the pain in my side was pretty unbearable.

Initially, the quack that I was seeing kept on giving me Motrin, Naproxen and most recently elavel.  I have been taking this for months and the refluxing (GURD (gerd)) started.  Feeling all choked up, always having discomfort in my throat, feeling like there was an obstruction difficulty lecturing (I am a teacher) as well.

I think all the pain meds have damaged my ability to keep the acid down in my stomach.  I am going to the doctor for this now in addition to the back thing.

The doctor gave me a TENS unit and it actually made me feel EXACTLY the same way you are feeling.  In the mean time, my physical therapist told me to forget the TENS unit and the pain pills and start making some posture adjustments and building muscle in my back and abs.

I can tell you that after 3 weeks of PT, two trips to the acupuncturist and no meds (except for Maalox once and a while for the reflux) and maybe some tums here and there, I am feeling a lot better.  I can now function 80% of the day with almost no pain, and the rest of the time, it’s not too bad.

Do yourself a favor and check out some COMPETENT physical therapy and maybe look into the prospect of doing some acupuncture for the pain.  It has worked wonders for me not only for the pain but to relax as well.  Don’t get carried away with the pain meds and make sure they are checking your kidney functions if you’ve been on pain meds for a while with a blood and urine test.

One final note for you from a 41 year old guy who has spent a lifetime being active and vital.  For god sake, DONT LET YOURSELF GET DEPRESSED and ANXIOUS to the point of despair.  With all that damage to your spine, you will likely not be as active as you once were and I can accept that, but I want the quality of my life back.  You can have this too, but DONT LET THEM CUT YOU OPEN unless its life or death!  Spinal fusions are not very successful.  Check out the Laser spine institute in Tampa Florida and let them evaluate your MRI's and see what they can do for you.

Best of luck and stay positive if you can, anxiety and depression will only worsen your condition and bring on new problems.  Believe me I KNOW ALL TOO WELL!  Fix your mind first, than start to fix your body!  This board is very helpful but don’t read too much into the stuff you get on the net, there is a lot of misinformation out there! Seek knowledge but seek GOOD knowledge.

[mike1105]

it is entirely possible that your thorcic back pain is due to weak mid and upper back muscles--especially the rhomboids and other posterior scapular stabilizers. you may also have tight and short scalenes, pec muscles and scms and upper traps. the muscles in your mid back need to be wtrengthened, especially with shoulder blade pinching exercises. cord "kinking" does usually not cause pain, but rather weakness and loss of function and numbness. the weakened mid bak comes most often from poor posture--- esecially forward head/hunched posture common in computer users. see a website by jolie booksapn and a book on posture by paul d'arezzo.

[PV92804]

Thank you for the replies.

FYI: I am not taking ANY pain medications other than Advil/Tylenol on a regular basis. I have Vicodine & Tylenol #3, but they both make me feel really, really sick & so I don't take them unless I am in unbearable pain. I do have a very high pain tolerance. I think it is because I have been in pain for so long, I can just live with it on a day to day basis. But it is affecting my quality of life, hence the reason that after all these years, I am seeking help. I know to take anything I read online with a grain of salt, but I can hardly stand going from dr. to dr. for different opinions either. That is why I have only seen 2 orthopedic MDs. The first one actually said there was nothing wrong with my back except arthritis, and all he did was x-rays.  I don't have chiropractic coverage, or I would consider that avenue, if anyone said it might help. I will look into the web site & book suggested.

[2Regina]

My own back history is long, so I'll spare everyone the lengthy read.  Having back problems for 35 years has finally led me to a procedure called a nerve ablation.  Anyone who has suffered back pain and has found no relief should ask their pain management doctor if they are a candidate for this procedure.  My health insurance covered it which was a big help.  Read about it on the internet and have your questions ready when you visit your doctor.  For me, this procedure is the miracle I have been waiting for and was not available for the spine 7 years ago (so I've read).  For the first time in 35 years, I am no longer taking any pain medication.  Thank G-d for modern technology!!!!  Life is good again.

[pstone]

pv92804,

well its nice to see someone else like me i had the exact thing in my neck i had the fusion with cage in jan07 C5,C6,C7 stenois, spuring , collapsed disk and spinal colmn collapsed. i did great with my neck. in may 07 i had L3 L4 L5 S1 fused with facet joints removed my nerves in my back was all twisted and mangled, compression at L5, bone spures, stenosis, now this surgery is another story not like my neck. but i dont give up i am in still pain that runs down both legs i am back and forth to the dr. i have a great spine dr in atlanta ga. he is the only one that found what was wrong with me and operated on me now if we can fix the leg thing i might be ok. i have come to the conclussion i will always be in pain. i take opana er 20mg 2x day, cymbalta 60mg for my mental, oxicodone 10/650 for break thru pain (which is all the time) i am now applying for social security disablity. But you know what you have to be strong, get tough and this web site really lets you know you are not alone there are many of us with the same problem. Over the last few months it has helped me so much so find a GOOD Dr. to fix it. I could have been paralized.

Good Luck
pstone