Diagnosing spinal lesions

[Adnvwsti]

I've had two c-spine fusions in my neck several years ago and a titanium plate was implanted during the last fusion to hold things in place.  Now, because of the titanium plate, I have been told that I can't have an MRI to determine if I have MS lesions on my spine.  The brain MRI revealed two fairly large lesions, but I don't know what an MRI of my spinal cord would reveal, although I can most assuredly guess with my balance problems, pain, falling, and other problems.  

I've been told, though, that the plate would create a starburst effect on the film and nothing would be seen.  But I am having so much pain in my lower back, generated at the bottom of my tailbone upward, that I'm wondering why an MRI couldn't be done on that region?  It is, after all, much further away from my neck area than my brain is!  Quix or Lulu or anyone, might you be able to provide an answer to that question?  I've also been told that there is a way to do an MRI on my upper spine, neck and shoulder, despite the titanium plate, but no doctor has bothered to go that far.  

I had a myleogram last summer, in the hope that a pinched nerve might be found--something that would explain all these symptoms away and then, maybe, it wouldn't be MS (denial, denial).  I wildly and foolishly hoped it would just be so casually explained--carpel tunnel, pinched nerves, etc.  But the myleogram revealed nothing and the procedure itself was a horrible nightmare.  The radiologist was a moron and did something that caused me to feel an enormous electrical current pass down my right leg, over and over. I felt as though I were being electrocuted. Knowing I should not move, all I could do was clench the handrails at the top of the table and cry as I said, "Please stop that.  You're really, really hurting me.  There's a strong electrical current in my leg!"  He knew he'd done something wrong and became frightened himself.  "Which leg?!" he asked.  "My right leg!", I said.  So he moved  moved the needle around in my spinal canal, causing incredible electric shocks in other parts of my body, and he tried moving the table to different angles, all the while saying in an agitated voice, "do you feel it now?  Is it getting better?"  It was total torture.  The shocks ran all over my buttocks, up to my neck and left shoulder.  I thought I would be paralyzed.  When he finally pulled the needle, he didn't even speak to me but left the room hurriedly.  I almost passed out from sheer relief.  After a few minutes, the head nurse in the room said, "You're a very good patient."  I replied, "No, I cried like a baby."  She said, very deliberately, "No.  Look at me."  I turned my head to look at her and she said again, "YOU are a very, very good patient."  I got the message that she was trying to say that what had just happened was not normal for most myleogram procedures.  

For two hours in the recovery room, the toes of both feet twitched uncontrollably and my calf muscles spasmed.  I could hardly stand afterward to leave and vomited for days afterward.  So...what kind of procedure would be done to check for lesions on my spine?  I never want a myleogram again.  The lumbar tap was nothing, but that myleogram was just horrible.  If there is an MRI that can be done to detect spinal lesions, I really want to know about it, but please don't say it would involve a myleogram.  

[Adnvwsti]

Thank you, everyone, for your responses to my question.  This clears up the picture for me!  And it should clear it up for any neuro I go to for care in the future.  My neuro has recently changed and he was not the one who suggested the myleogram or said that MRI's wouldn't work because of the titanium plate.  That error belongs to the internal diagnostician and orthopaedic surgeon who said it before I got the dx.  At least it's over now and I can just say:  well, definitely, EVERYTHING else was ruled out quite effectively on the road to the dx.

[Quixotic1]

I realized that I completely missed your whole posts on what your have been through in the way to gettting a diagnosis.  I am so sorry.

Like poorkid states, I didn't think the titanium plates completely made an MRI unreadable.  Since you have a diagnosis, it isn't critical to see every part of the CNS.  It is nice to have a baseline, but treatment does not depend on seeing lesions in the spinal cord.

Any MS lesion would be found in the spinal cord - which ends right at about L1.  The actual lumbar spine does not hold any part of the spinal cord.   I am with you.  I don't see any reason why the lumbar spine cannot be imaged.  I wonder if you need to see a different doc to get this done.

Once they rule out stenosis or pinching of the nerves in the lower back, you can pretty much know that the pain you are in is nerve - or neuropathic - pain.  That is treated with different meds.  Regular pain meds, including the narcotics, are not very useful with this type of pain.

There are a couple of Health Pages that you might find useful.  They are the one dealing with spinal cord lesions and their symptoms, and the two on understanding nerve pain and treating nerve pain.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Spinal-Cord-Lesions/show/764?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Nerve-Neuropathic-Pain---A-Primer/show/371?cid=36

http://www.medhelp.org/health_pages/Multiple-Sclerosis/General-Principles-of-Treating-Neuropathic-Nerve-Pain/show/452?cid=36

I hope this helps.

Quix

[poorkid]

I have a titanium plate, three screws, and a fusion from C2 through C6.  My neuro was able to diagnose me based on "signal change" in my cervical spine.  Although there was a great deal of artifact on the MRI, he compared it to my previous MRI and was able to read the changes in the MRI.

I have had at least 12 cervical MRI's in the past 3 years and have never had any problems with the pictures showing my lesions.  A good MS neuro is able to decipher the images although he states that it is extremely difficult to do so.

There has never been any problem for me with a cervical MRI.  I have not been imaged on a machine higher than a 1.5 so that may be a deciding factor.

[shoshin]

That myelogram sounds perfectly awful. I'm sorry you had to go through that.

I think I saw that you are already dx'd with MS. In that case, there may not be any advantage to a spinal MRI, except to add to your knowledge store (and bills to pay). It seems that a lot of neuros do not do f/u spinal MRIs because if you get a new lesion on the spine, it is usually eloquent, i.e., it has some kind of effect that can be identified. This is in contrast to brain lesions, many of which are silent, i.e., have no discernible effect. So the biggest reason they do f/u brain MRIs seems to be that you could unknowingly be accumulating a lot of brain lesions, which could be a reason to change treatments.

If the spinal MRI results wouldn't make any difference to anything that you're doing, I wouldn't worry about it. If your neuro is competent, s/he should be able to tell if you have spinal lesions from the exam and history.

My two cents.

sho

[michelleric]

I am so sorry you had to go through such a torturous procedure, sounds awful!

With regards to the Spine MRI, I too have a titanium plate in my cervical spine. Had 2 discs fused and left with the plate and 6 screws. I have had a spinal MRI since, and my neuro can see the thoracic spine fine, and yes, there is a bit of the "starburst" on the MRI from my cervical spine, but my neuro could read it ok. I, unfortunately have another herniated disc above the 2 I had fused, but it is not pressing on my spinal cord, so we are leaving it alone.

I know they can still do the spine MRI, but yes, it is not as clear as before. I wish you well.
Michelle