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Thread: In The Foraminal Stenosis Club - FEEDBACK?

  1. #1

    Exclamation In The Foraminal Stenosis Club - FEEDBACK?

    So in the wake of pain in my posterior deltoid, radiating up into my elbow and thumb (on my left arm, my 'good' arm, in which I have some usable fine motor, the center of my independent life), also pain in traps, I had an MRI to track narrowing in spinal canal which was present 5 years ago. I DONT think I have any weakness or restricted range of motion, but I do have some tingling, burning, though it *could* be injury from some things I've been doing over past 6 months. My findings:

    Narrative
    Technique: Sagittal T1-weighted and fat-suppressed T2-weighted FSE
    sequences, as well as axial T1-weighted, T2-weighted FSE, and gradient echo
    sequences, were obtained of the cervical spine. A sagittal STIR was also
    obtained.


    Findings:
    The visualized posterior fossa is normal in appearance. There is kyphotic
    curvature of the cervical spine, decreased from prior, with mild
    retrolisthesis of C5 on C6. There is a new mild anterior height loss or
    superior endplate depression of the C7 vertebral body with mild low T1,
    high T2 signal within the superior aspect. Unchanged mild-moderate anterior
    wedging of the C5 vertebral body. Mild endplate reactive changes at C6. The
    spinal cord is decreased in caliber from the C4-C6 levels, similar to
    prior, with associated mild high T2 signal likely reflecting myelomalacia.


    C2-C3: Tiny disc bulge, unchanged. No mass effect upon the cord or
    foraminal narrowing.


    C3-C4: Tiny disc bulge, unchanged. No mass effect upon the cord or
    foraminal narrowing.


    C4-C5: Small broad-based disc and osteophyte, right greater than left. No
    mass effect upon the cord or foraminal narrowing.


    C5-C6: Unchanged large broad-based disc and osteophyte, right greater than
    left, resulting in narrowing of the ventral CSF space and abutment of the
    spinal cord. There is moderate-severe bilateral foraminal narrowing.


    C6-C7: Disc desiccation. New large broad-based disc and osteophyte, right
    greater than left, resulting in narrowing of the ventral CSF space and
    severe bilateral foraminal narrowing.


    C7-T1: New moderate right paracentral disc protrusion resulting in
    narrowing of the ventral CSF space and moderate right foraminal narrowing.
    Susceptibility artifact posterior to the T1 level is again noted, likely
    from Harrington rods.


    Impression:
    1. Increased degenerative disc disease including new large disc and
    osteophyte at C6-C7, as above.
    2. New mild superior endplate depression of C7 with associated high T2
    marrow signal which may represent degenerative endplate changes or an
    acute/subacute Schmorl's node. Although a superior endplate fracture could
    have a similar appearance, this is considered less likely in the absence of
    recent trauma.

    I have to say, this REALLY worries me. The balls in my court based on subjective belief as to how much my symptoms interfere with independence, if I choose they will do steroid injection to the site. Surgery (foraminotomy?) not discussed.

    For record, I am a 42 y/o incomplete C5-6, no triceps, manual chair user

    Thoughts? Feedback?

    Thank you for any & all comments!

    Lee
    Attached Images Attached Images  
    Last edited by LeeinNC; 03-02-2016 at 07:50 PM.

  2. #2
    Several things to be commented on

    At C4-6 and T-2 spinal cord level there is pressure on the spinal cord narrowing at C4-6 (stenosis)
    T-2 myelomalacia means that the spinal cord is bruised at that level

    Then the schmorl's nodes are indicative of some damage to the spine bones

    https://en.m.wikipedia.org/wiki/Schmorl%27s_nodes

    are there plans to have you seen by a neurosurgeon? The pressure on your spinal cord needs to be removed
    the pain/ tingling is from that. You run the risk of losing arm function altogether to those areas

    who ordered your test?

    pbr
    Last edited by SCI-Nurse; 03-04-2016 at 09:33 AM.

  3. #3
    Thank you PBR!

    Was always told my paralysis was from bruising, this confirms that damage, thank you for explaining the vocabulary, I was ignorant

    'indicative of some damage to the spine bones'

    You mean trauma? Or wear-and-tear over the years? I've been injured 28 years.

    I have had 2-3 falls over past 4 years I worry may have added to, however ER visits did not show damage at the time.

    No referrals to see a neurosurgeon, his course is to do injection if I give go-ahead, mainly diagnostic, says if we see improvement that confirms this issue is causing, then we move forward to possibly more involved processes.

    Physiatrist ordered MRI

    Injections do concern me, reading a lot about inefficacy and risk of scar tissue.

    I am getting a second opinion from local spine center, that referral taking time

    Thank you so much, I am quite scared/worried here, the anxiety alone is taking a toll

    Lee
    Last edited by LeeinNC; 03-03-2016 at 06:18 PM.

  4. #4
    I think I have had or have some of the same things you're experiencing. Since the day of my accident I've had continuous pain in my rt. shoulder blade area. After 8 years of trying anything from acupuncture to Botox to drugs, it was finally determined I had a herniated disc between C4 and C5. This determination was made after trying 2 nerve block shots that didn't work. While laying in the gurney, waiting for the 3rd nerve block shot, the neurosurgeon determines that the 3rd shot won't probably work like the first two, so let's not do the shot. He refers me to a colleague who looks at my MRI, which has already been reviewed by 3 other neurosurgeons, and says here's the problem, pointing to a herniated disc. The solution, fuse C4 and C5. Keep in mind, because of my accident I'm already fused from C5 to essentially T1.

    I had the surgery in December and the results thus far are not impressive. I've had pain in my rt. shoulder blade more intense than I've ever had. I'm also experiencing pain in my left shoulder blade area that I've never had before. The best way to describe the pain is it's like having the same pain as a cramp in your calf, only it doesn't ever go away. The surgeon has recommended that I have massage therapy of my neck and shoulder area in order to unravel some of the nerves from my neck and shoulder muscles. In about 4 weeks then I'll have a CT scan of my original surgery to make sure there isn't something in that area causing the problem. I can say that after 2 weeks of massage therapy the pain in my left shoulder blade area has subsided quite a bit.

    Good luck with whatever decision you make.
    DaDutchman
    C5/C6 since 2007 due to car accident

  5. #5
    When you have pressure on nerves and it has been there a long period of time, it is difficult to tell whether you will get return in nerves or experience permanent damage with the pain. Whenever neurosurgery is done, the goal is to prevent further damage from occurring and prevent losing function. Nerve pain (neuropathic) is difficult to deal with. Your pain receptors have been altered to know a different baseline. I hope you have a good provider who can treat or offer you with a variety of treatments: oral medication, topical creams or gels, therapies, psychotherapy, biofeedback, etc.

    pbr

  6. #6
    In connection with my above post, I am researching the best places in the US to be evaluated for possible treatment/surgery vs monitoring, interested in referrals for both North Carolina & beyond/continental US

    PLEASE weigh in if you have ideas, and thank you so much for taking the time!

    PBR - thank you again! Thing is I am just now becoming aware there WAS pressure on the nerves, to date my symptoms have all been framed as normal wear and tear, never correlated with this narrowing. Trying to not be suspicous of my care, but also trying to be proactive

    In his defense, he HAS to date offered all the options you list, I think he sees surgery as an absolute last resort, as I have damaged lungs which would not fare well under anesthesia and recovery, I am a near drowning victim. Thing is I JUST CANT HELP looking at the image and thinking the pressure there needs to be relieved.

    ALSO: the text from my MRI 5 years ago:


    Technique:
    Sagittal T1 and T2 FSE with Fat Sat, Axial Gradient Echo, sagittal STIR,
    axial T2 and T1.

    Findings: Of note, there is metallic artifact from probable Harrington
    rods which effects the sagittal T2 fat suppression images at
    approximately the C4-C5 level, obscuring the cervical spinal cord and the
    bony elements at this level.

    There is a focal kyphosis of the cervical spine with apex at
    approximately C5 where there is loss of the cervical vertebral body
    height consistent with wedge deformity. There may be minimal
    retrolisthesis of C5 on C6. There is mild loss of height of the C6
    vertebral body as well. Remaining vertebral bodies are otherwise normal
    in height and contour. No discrete bone marrow signal abnormality. Facet
    alignment is within normal limits.

    There is cord attenuation, flattening and irregularity consistent with
    myelomalacia, starting from the endplate of C4 and terminating at the
    level of mid body of C6. Hyperintense signal is noted centrally within
    the cord at this level, and is most consistent with myelopathy, as a
    result of prior trauma. There is no evidence of posttraumatic syrinx.
    There is mixed hypo and hyperintense to CSF material about the injured
    cord consistent with flow artifact. The craniocervical junction is
    unremarkable.

    C 2-3: There is a small disc bulge which minimally flattens the ventral
    CSF. There is no neuroforaminal narrowing. There is mild bilateral
    uncovertebral arthrosis. No facet arthrosis is also appreciated.

    C 3-4: Very small broad-based disc bulge with mild bilateral facet
    uncovertebral arthrosis is appreciated without neuroforaminal narrowing.
    There is no significant facet arthrosis bilaterally.

    C 4-5: There is no significant disc bulge. No neuroforaminal narrowing.
    The kyphosis results in narrowing of the ventral CSF space.

    C 5-6: Posttraumatic deformity of the C5 vertebral body with right
    greater than left disc osteophyte complexes. There is minimal
    retrolisthesis of C5 on C6. There is a focal bony prominence from the
    deformity impinging on the right neuroforamina. Disc material appears to
    extend caudally to just below the disc level. This also contributes to
    moderate to severe right neuroforaminal narrowing. There is left moderate
    to severe neuroforaminal narrowing.

    C 6-7: There is a broad-based disc osteophyte complex with right
    eccentric bony deformity and disc material extending caudally. There is
    moderate to severe foramina narrowing and mild to moderate left
    neuroforaminal narrowing.

    C7-T1: Moderate sized right eccentric disc osteophyte complex with disc
    material extending slightly cephalad. There is mild impression on the
    dura. There is moderate right neural foraminal narrowing. No left


    neuroforaminal narrowing. No significant central canal stenosis.


    Impression:
    1. Posttraumatic changes of the cervical spine with wedge deformity of C5
    and minimally of C.
    2. Posttraumatic myelomalacia changes of the spinal cord from the C4-C5
    through C5-C6 without posttraumatic syrinx.
    3. Multilevel posttraumatic changes and degenerative disc disease with
    right neuroforaminal compromise from C4-5 to C7-T1, as described above.


    I have reviewed the images and concur with the above findings.




    Lee

  7. #7
    Thanks PBR. My surgeon told me to expect it to take some time for that nerve to come back to its' original size, so to speak. The massage therapy is definitely helping the left side, but then again those nerves haven't been under stress for that long of a period of time. Topical creams like Tiger Balm and Solanpas do bring about relief for a couple of hours. Hot showers also offer temporary relief. I was taking 10 mg of valium at night and that seemed to work well until I developed a hypersensitivity to opium based pain killers. I also decided to avoid valium as long term use led to memory loss and I was experiencing some of that. Finally, my surgeon has recommended the use of a "tens" unit as part of my physical therapy. I'm hoping we'll be able to incorporate that this week.
    DaDutchman
    C5/C6 since 2007 due to car accident

  8. #8
    The shoulder bladder area is from C6 nerve. (I know this because I asked the ANESTHESIA/pain Doctor why is that area of- MY LEFT SHOULDER BLADE pain AND IT DROVE ME CRAZY. The ESI did help some. You should try Naproxen 500 twice a day. Do you have spasms? I have this same problem following a car accident. If I take the Naproxen, and muscle relaxer it helps some and also I do stretching exercises. Does your shoulder roll forward? That is due to some weakness and it makes the pain worse. ( and why so many looked hunched over). Best to make sure blades are back against the chair- that will make the muscles stronger, if possible.


    C6-C7: Disc desiccation. New large broad-based disc and osteophyte, right
    greater than left, resulting in narrowing of the ventral CSF space and
    severe bilateral foraminal narrowing.


    C7-T1: New moderate right paracentral disc protrusion resulting in
    narrowing of the ventral CSF space and moderate right foraminal narrowing.
    Susceptibility artifact posterior to the T1 level is again noted, likely
    from Harrington rods.

    These were my areas of focus, but hard to say without comparing with other MRI. The surgeons don't usually like to operate on dessicated disc.

    Dessicated disc-kind of like crumbled chalk.


    CWO

  9. #9
    Sorry CWO for taking so long to get back to you. I do not have spasms as a general rule. Since that pain in my right shoulder blade area was so intense from the time of my accident, I was prescribed a number of different pain medications. None of them really worked that well. When I was first doing outpatient therapy I was working with a PT who was somewhat into bio-feedback. After one of our failed sessions I had her put the electrode on the spot that hurt in my right shoulder blade area. The output showed muscle activity off the scale. Gradually I came to find the most relief from Valium or Atavan. I was on Valium a couple of years before I had to get off of it.

    Since my surgery to fuse C4 and C5 together because of the herniated disc in between, I haven't been very satisfied with the results. The one neurosurgeon I went to was convinced my shoulder blade pain was due to something related to the C4 vertebrae. I was going to therapy whereby the PT was doing various forms of massage therapy which were not bringing about any changes to my condition. It was getting very frustrating to say the least. Yesterday we may have finally achieved a break-through. I was working with a different PT who was a little more skilled in treating the neck area. She was doing her initial e-val and noticed that a few of my cervical vertebrae were not properly aligned. They were slightly twisted. She spent a good half hour working on that area and I was finally starting to feel some relief. At the end of therapy another therapist, who had done some research on different taping techniques, taped the back of my neck and both shoulder blades. For the very first time I felt completely free of pain in the rt. shoulder blade area w/out having to use significant quantities of some type of medication. This relief also lasted for almost 30 hrs. The longest period of time by far that I had experienced pain relief. My surgeon had prescribed some type of muscle relaxer that did absolutely nothing.

    So at this point, come Monday morning, when I'm back at therapy I'll have the therapist align the cervical vertebrae again as well as tape my shoulder blades back again. It does appear, FINALLY, that I may get long term relief in that area w/out having to resort to different types of medication.
    DaDutchman
    C5/C6 since 2007 due to car accident

  10. #10
    Great! I love Naproxen! It cuts down on the inflammation! And there are all types of "therapy" that can help. Therapy instead of and/or after is very important! And hteir are therapists who have "spine" experience. So glad relief is looking possible! CWO

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