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543578 tn?1214412007

Need Advice on new MRI findings

I will try to get right to the point.  I was injured on the job in Dec 03. And sustained severe multiple injuries. But I will only focus on my back for now. On 4-6-07 I had a Anterior Cervical Discectomy with fusion at C5-6 and C6-7 with hardware, due to spondylosis of the cervical and thoracic spine C5/C6/C7 with multilevel neuroforaminal stenosis at C5/C6/C7.  Then on 12-11-07 I had an emergency surgery Lumbar discectomy and foraminotomy of L5-S1, due to a blown disk.  After all that I have still been in excruciating pain so my QME ordered another cervical MRI.  This is what it says.

There is mild curve from C2 through C4 and there is moderate anterolisthesis of  C4 on C5
C2-3 there is significant central canal and foraminal stenosis
C3-4 moderate disc bulging is present
C4-5 there is a broad based right paracentral disc protrusion causing moderate deformity of the right anterior cervical cord.
C5-6 A broad based left paracentral disc protrusion causing moderate deformity of the left anterior cervical cord. There is moderate right and severe left foraminal narrowing.


I need someone to help me understand what is happening to me. Dr’s are now trying to come up with a solution
Is my condition worsening?  Can these new findings require more surgery? I tried to look up the meaning to these medical terms but didn’t get far.

I am afraid I will end up in a wheel chair or worse. Im a 43 year old female truck driver.  
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543578 tn?1214412007
Hi I have some updates I need your help with.

I just received a notice of award saying they approved my application for disability benefits. The rate is $396.70 beginning November 2004. but I will not receive regular monthly checks at this time.. Then it goes on to say we are reducing your monthly social security checks beginning november 2004 which is the first month you were entiltled to both social security disability and worker's compensation payments. Then it says you are entitled to hospital insurance under medicare beginning November 2006, and you are entitled to medical insurance under medicare beginning April 2009 and they will send me my medicare card. Then it says they will continue to bill me for my medicare part B premium... my question is what does all this mean?? I got injured at work on 12/11/2003 and I am receiving worker's comp benefits. I am totally temporary disabled and have not been made P&S yet. I am 43 years old and I am struggling as it is just living on workers comp alone. How am I suppose to pay for this part B premium?? I do have a worker's comp attorney can anyone tell me if there is anything I can do about this? do I need to hire a disability advocate?? any advice or suggestions would be greatley appreciated.
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Avatar universal
In general mental health issues are difficult to support a work comp claim if they are the primary issues that initiated the claim.  In your instance, the clinical psychologist is attempting to include the mental health issues as a secondary portion of the claim resulting from the trauma and its aftermath.
This would be very reasonable and could affect the amount of permanent disability you are given at the settlement of your claim.  I would not hesitate to avoid this as it will most likely be in your favor.
As for weaning you off the anti-depressants:  there are so many new and different psychotropic meds available now and they differ in their composition and effects.
Anytime there is a change in meds, you need to be weaned off the old drug slowly while incrementally increasing the new med.  It can be somewhat frustrating during the switchover, but he would be monitoring you closely for potential ill effects.  Once he is able to determine your response, it might be a more effective drug in the longterm.
If you have trust in your doctor and his ability to assist you through the process, it could be very beneficial.
I admire your fortitude ---
Helpful - 0
543578 tn?1214412007
Hi
Just an update I went to a Clinical Psychologist today which was recommended by my QME and my Primary.  And he said that I suffer from post-traumatic stress syndrom and some other terminology he used which I can't remember, but he did said he is going to include in his report that due to the circumstances and ongoing mental issues I am experiencing he recommends incorporating the mental health issues into my lawsuit. He also mentioned that he would like to wean me off of the anti-depressants like effexor er and prestiq which are taking its toll on me and try some different methods. Is this a good thing?  From what I understand it is next to impossible to have a mental health case incorporated into a workers' comp lawsuit.
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Avatar universal
Glad your attorney is working for you now --
SS may have some legal constraints on the amount paid at one time. I am not sure how that is determined (through legislation?)  It is only important that you get the full compensation owed for your injury and lost work.  They are very good in doing the math!
Once the initial payment is received, the monthly checks are sent regularly and on time.
Direct deposit to your bank account is recommended.
Helpful - 0
543578 tn?1214412007
Hi

Yes I do have an attorney and at first things were not getting done by her. So I had to talk to my QME and he is the one who got after her and got the ball rolling and since then she has been on top of things. Social Security did schedule an appointment for me with one of their Doctors and one of their Mental health doctors which I did go to both appoinments.  Both of Social Security Doctors were just amazed how I can still function considering all the pain and everything else I have been through.  SS did send me a letter saying that if I was approved they were willing to back pay me from the date of injury 12/11/2003 cause I did apply in 2004 by was denied because they said that my injuries were not that severe but now all that has changed they said.  And yes they also told me the amount would be alot so they can't pay me all at once they would have to break it down into 3 payments. Is this true?
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Avatar universal
Social Security Disability (SSDI) is permanent disability.  The paperwork process is very lengthy and then there is a face-to-face interview with one of the case workers to review any and all assets you have and other sources of income.  It can be frustrating, but you just need to hang in there.  
Are you represented by an attorney?  I did not need to use one as my disability was fairly straightforward --- my doctor was great in providing documentation.  Still it took a year from application to approval.  They do pay you from the start of your disability, so it is a large sum in the beginning.  The monthly income will be based on your income during several quarters while you were working (similar to state disability).
Hope all goes well ----
Helpful - 0
543578 tn?1214412007
I already filed for ss disability.  Do I also need to file for permanent disability? or is it one of the same?
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Avatar universal
Well, at least you are getting confirmation of why you have been having so much pain!
Thoracic outlet syndrome is a complex process and you probably will need more factual information regarding the symptoms, causes, treatment options, support groups etc.
Check this web site:  www.Medifocus.com  and in the search box enter "thoracic outlet syndrome"  It will bring up the outline for a guidebook that provides extensive detail regarding this chronic pain syndrome.  It costs a little bit of money, but the value of the information makes the expense worthwhile.  I think it might help in getting explanations and a clear understanding of the current medical management.
You are on quite a bit of  medication at this time and if it is providing appropriate comfort, a morphine pump can be addressed at a later date.  It is a decision not entered into lightly --- but it does provide a direct administration of pain med (morphine) and avoids the GI problems so many people encounter with oral medications.  It does require surgery (usually implanted subcutaneously in the abdominal area) and intermittent followup to refill the pump.
As this is a work related injury, you are going to be offered the treatment advised by the QME -- it would be helpful for you to have adequate knowledge of all options available at this time.  Have you or are you considering applying for permanent disability?
You must be one strong cookie!

Helpful - 0
543578 tn?1214412007
Hi kittyluv1

Well I just came home from the dr appt and and this is diagnosis.  I did have the 2 level fusion at C5-6 C6-7 so there is nothing there. and the fusion healed beautifully as he put it. But now,  I have Vascular Thoracic outlet syndrome which is affecting my brachial plexus Also significant herniation at  (T4 to T9) and to make it worse their is significant bulging at C1-3 causing nerve root compression and moderate narrowing of the canal.

He said that the Cervical MRI series shows things that were NOT documented on the MRI report which he said is not uncommon for the MRI technicians to overlook.  He also mentioned the recent EMG / NCS  testing I just had done 1 month ago confirms his diagnosis. so now he said he will submit his finding and report to the other parties involoved but he said he wants for another Neurologist to see me just for a second opinion. He mentioned it might be necessary to cauterize the nerves but informed me that my neck movement would be very limited. Is this true.

So now my medications include:
Norco
Opana
MS-Contin
Amrix
Valium
Sonata
Flector Patches
Voltaren Gel  
Senna

I have refused to have the morphine pain pump inserted.
Helpful - 0
Avatar universal
You are most welcome!  I was an RN for 27yrs before retiring due to my disability.  I've learned how to translate "medicalese" over the years.  I do wish doctors could be more cognizant of the fact that most people they see haven't a clue what they are talking about --- it really helps to use simple English as you have so thoughtfully noted.

Your primary doctor is correct in that your MRI shows increased degeneration above the fusion level.  I am still of the impression that your fusion did not include the C5-C6 level based on the MRI report and there is nothing lower than C6-C7 other than the thoracic spine. Just nod and say "OK".  At this point it will be the neurologist assuming primary responsibility for your ongoing medical treatment.  He may want to try conservative txmt or he could refer you back to your prior surgeon.  Here's hoping you don't need additional surgery as yet.
Please keep us posted!

(P.S.  Thanks for the kind words ---)




Helpful - 0
543578 tn?1214412007
Hi
I just want to say thank you for taking the time to read my question and sending me some useful feedback.  You know I asked my primary How can I have problems still with my C5-6 & C6-7 when there are no disc there anymore?  He said to me that actually your right their are no disc there anymore but your injury was so severe that it has probaly affected the disc above and below the fusion area. Does that make any sense to you?.  I fully understand now what is happening to me.  You explained everything to me in a way that I can finally understand (SIMPLE ENGLISH TERMS) not medical terminology that most of us are clueless to. I do have an appointment tomarrow with my primary and a neurologist to go over the MRI films and MRI report. So I will post a followup sometime tomarrow night and let you know my findings.  Again Thank you so much.
Helpful - 0
Avatar universal
Welcome to the Back and Neck Community.  Members are here to provide assistance and support to individuals experiencing symptoms related to possible abnormal conditions of the cervical and/or lumbar spine.  Advice given is non-professional and is based primarily on personal experiences.  Please post on the Expert Forum if additional medical advice is needed and one of the medical doctors will respond as appropriate.

I am sorry to hear of your continued health problems.  It sounds as if the accident was quite major and the difficulty you have been experiencing must be frustrating to say the least.
Fusion of the cervical discs involves removing all of the intervertebral discs and replacing it with cadaver bone and stabilizing the spine with titanium plate and screws until the cadaver bone knits together with the upper vertebrae and produces a solid fusion.  The length of time to achieve complete fusion can be 6-8 months or longer.  Once the fusion is done, however, greater stress is placed on the remaining vertebrae as they take up the slack from the discs that were removed.  This puts all fusion patients at risk for  needing additional surgery at a later date depending on how much degeneration occurs and the extent of nerve compression.
Your MRI findings do show some increased degenerative changes.
The mild curve from C2-C4 is a change in the normal curvature of the cervical spine and can be related to associated muscle spasms.  The anterolisthesis of C4 on C5 means that the vertebra of C4 has shifted anteriorly and is probably placing some pressure on the exiting nerve roots at that level.
When there is degenerative disc disease and shifting of the vertebrae, it results in a narrowing (stenosis) of the central canal (through which the spinal cord travels) and of the foraminal space (through which the nerve roots travel).   Depending on the amount of stenosis the spinal cord and/or the nerve roots could be pinched and would result in symptoms of pain, tingling and numbness etc as occurs with a herniated disc.
You have moderate stenosis at the C2-C3 level, but there is no documentation of nerve compromise.
At C3-C4 there is moderate disc bulging -- the disc is causing the annular covering to change shape, but no actual disc herniation is documented.
At C4-5 there is disc protrusion which is causing deformity of the right anterior  spinal cord itself.
At C5-6 there is disc protrusion showing deformity of the left anterior spinal cord as well as the foraminal stenosis on both the left and right sides.
All of the above would be contributing to your symptoms of pain and nerve compromise.
However, if you did indeed have a fusion at the C5-C6 level, there should not be any disc left to cause the documented disc protrusion.  Perhaps your fusion was only done on the lowest cervical disc level of C6-C7.
These degenerative changes could indicate the need for additional surgery as the spinal cord is currently being compromised.  The extent of that compromise needs to be determined by the neurosurgeon and the potential does exist for discectomy and fusion at that level.  Hopefully you have an appt with the surgeon to dicuss your treatment options.
I recently had anterior cervical discectomy and fusion with hardware done C4-C7 so I can understand your concerns regarding further disability.  These issues need to be discussed with your primary physician/surgeon and you will need to make decisions based on the potential complications, whether doing surgery or not.
I hope that you do find appropriate medical txmt and that you have a successful outcome.  My surgery was very successful and I wish the same for you.
Please post back and let us know of your progress and any additional questions/concerns you may have.
Best wishes ----

  

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