Cspine MRI: Radiologist findings dismissed/disputed by neurosurgeon

[hopefulbutwearingdown]

Hello,

My question is...  Would it be reasonable and/or, would it be likely that a radiologist would change his impression with regard to significant negative findings on an MRI for a symptomatic patient (symptoms are consistent with MRI findings) based solely on the neurosurgeon stating he disagrees with the findings based on the fact that he "knows" because he did the surgery.   I have included a little more history below for you...

I was a healthy, fit Critical Care Paramedic who suffered a major neck injury.  I had pain with paresthesias, progressing to weakness and muscle atrophy over a 4 week period in my left arm.  I underwent C5-C7 Anterior discectomy with instrumentation, Radical C6 corpectomy with cage graft and anterior plate.  3 months s/p surgery, I had many of the same symptoms so DPT referred me back to the neurosurgeon.  I had an MRI with IV contrast at that time.  

Significant MRI findings:

C5-6  The ligamentum flavum is mildly hypertrophied.  The neural foramina are severely narrowed, left worse than
         right.  There is mild susceptibility artifact from the surgical hardware in the vental spinal canal.
C6-7  The right neural foramen is severely narrowed.  The left neural foramen is moderately narrowed.  There is
         susceptibility artifact in the ventral spinal canal.

My neurosurgeon told me "everything looks great' and handwrote "neural foramina are wide open" on that report.  When my physiatrist read the report, he had immediate concern, obviously, I was symptomatic.  He called my neurosurgeon while I was in the office and was informed that there will be an "amended radiology report" reflecting the neural foramina are in fact, "wide open".  I was told to "get back in to life and I would be fine". To date, that amended report does not exist to my knowledge.  It's now a year later... I am still miserable, I have worsening symptoms and now I am being told my symptoms are "all in my head".  This is ridiculous!

[xmelax35]

I just saw what the doctor said above. I asked my radiologist that did mine to look over it again and he revised mine. I agree with the what Dr above said.  However it didn't make a difference, as every Neuro has a different opinion about issues. Some ignore them and some just don't even look at the radiologist report. I asked about something the radiologist put on there and the neuro said:, "I don't see that" "there is nothing on there that says that". I then pointed out that I had a copy of the report and said it says it right here. He then again said, "I dont' see anything on there that says that" and I was reading exactly what it said. So every Neuro is different. It doesn't hurt to get a 2nd or 3rd opinion from different surgeons, in my opinion. Sometimes it takes awhile to find one that will really look at it.

[Eric Wang, MD]

Sorry to hear that you are still in pain. Radiologist can and will amend reports if we see fit, but it doesn't really change your unfortunate situation.  The patency of neuroforamina is highly subjective, but certainly "wide open" is far different from "severely narrowed."  Have a discussion with your surgeon and physiatrist about amending the report if you want, but will probably only possibly affect  insurance payment.