Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does My MRI Test Result Indicate?
Question: I am scheduled for a 2+ posterior laminectomy and discectomy with fusion and instrumentation next week. I have had prior anterior cervica fusion done 10 years ago twice for one level. I am terrified of this surgery. My symptoms of arm pain are right side: feels like tennis elbow. Left side: sometime shoulder pain and sometime upper arm pain. The CT scan results were: Prior discectomy and fusion from C5-C7. Callus or osteophyte continues to narrow the spinal canal. Facet and uncovertebral joint hypertrophy result in persistent neural foramina narrowing. Persistent disc bulges and/or protrusions from C2-3 through C4-5 most pronounced at C4-5, result in stenosis and spinal cord impingement. Osseous degenerative change without acute osseous abnormality. The MRI shows: Fusions at C5-6 and C6-7 have not changed compared to prior exam of 8/27/14 and no canal stenosis at either one. There is a central non-calcified protrusion type disc herniation C4-5 which has become larger, thicker and broader to the right and now indents the spinal cord in the midline without myelomalacia. The smaller bulge with small central protrusion type disc herniation at C3-4 has progressed as well but is not compressing the cord. I would like to know if this is serious enough for the multi-level decrompession surgery suggested. I am told it will be 3 months recover, what will my recovery look like. I am not handicapped now and don't want to be by doing this surgery.
I answered the question on medications wrong, I have not tried any meds I don't have pain enough to be on medications really. Just Ibuprofen prior to this but off of any meds now due to surgery.
I answered the question on medications wrong, I have not tried any meds I don't have pain enough to be on medications really. Just Ibuprofen prior to this but off of any meds now due to surgery.
Brief Answer:
If cord compression signs it is necessary.
Detailed Answer:
I read your question carefully and I understand your concern.
Indications for surgery are often a subject of debate, opinions may vary among physicians, some are more aggressive than others. Looking at the imaging reports I believe the level which mostly worries your doctors is the C4-C5 one where the disc herniation is indenting, which means it may be compressing the spinal cord. For the moment it hasn’t caused irreversible damage, no myelomalacia, but they want to prevent that from happening, especially considering that the bulge has increased compared to prior exam.
Now I understand that you consider the pain manageable, but when it is a case of cord compression it is not only the pain which has to be evaluated. Cord compression may lead to weakness of the muscles of the upper and lower limbs, trouble with balance and coordination, difficulty performing daily tasks. So if apart from the pain there are signs like increased reflexes, muscle weakness and atrophy, combined with compression of the spinal cord, then that compression has to be relieved before it causes irreversible changes.
For that reason if there are such manifestations I would say the surgery is really necessary and you should do it. If you are fully functional and no such manifestations are found (but that has to be discussed with the doctor who makes physical exam, not necessarily signs noticed by patient) then decision for surgery is debatable, a wait and see tactic, continuing with physical therapy, may be chosen.
I remain at your disposal for other questions.
If cord compression signs it is necessary.
Detailed Answer:
I read your question carefully and I understand your concern.
Indications for surgery are often a subject of debate, opinions may vary among physicians, some are more aggressive than others. Looking at the imaging reports I believe the level which mostly worries your doctors is the C4-C5 one where the disc herniation is indenting, which means it may be compressing the spinal cord. For the moment it hasn’t caused irreversible damage, no myelomalacia, but they want to prevent that from happening, especially considering that the bulge has increased compared to prior exam.
Now I understand that you consider the pain manageable, but when it is a case of cord compression it is not only the pain which has to be evaluated. Cord compression may lead to weakness of the muscles of the upper and lower limbs, trouble with balance and coordination, difficulty performing daily tasks. So if apart from the pain there are signs like increased reflexes, muscle weakness and atrophy, combined with compression of the spinal cord, then that compression has to be relieved before it causes irreversible changes.
For that reason if there are such manifestations I would say the surgery is really necessary and you should do it. If you are fully functional and no such manifestations are found (but that has to be discussed with the doctor who makes physical exam, not necessarily signs noticed by patient) then decision for surgery is debatable, a wait and see tactic, continuing with physical therapy, may be chosen.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your fast reply. My neurosurgeon is more worried about the stenosis and the fact that the last two times were pretty acute disc bulges with damage to the spinal cord. What I am uncertain about also is that he wants to "go back to the old fusion sites" and "clean them up". So we are talking 4 or 5 levels to "fix it once and for all". So that seems very aggressive. If I do that, do you think it will be 3 months to recover or longer? 10 Years ago, that same surgeon told me that, if they have to go in from the back, i.e. posterior, it would take 6 - 8 months to recover. Initially, he told me 4-6 weeks out of work and now they are saying 3 months. Any opinions on going in to "fix it all" instead of 2 levels only (not including C2-3 or cleaning up the previous fusion sites?) and recovery time, based on your experiences with patients overall?
Brief Answer:
Read below.
Detailed Answer:
Hello again.
I must say I find your perplexity justified.Judging by the MRI report those fusion levels seem to be just fine, do not cause any stenosis, so I must say I am not that sure about what he intends to clean up really, unless he sees something else than the report. As I said I can agree with surgery for the C4-5 level where there is the compression worry (due to the stenosis by the bulging disc), not sure about such an aggressive approach. So I would discuss that with him again.
As for recovery times it depends by what one means by that. The time for the fusion itself to happen, to merge together, is 3 months. Exercises programs possibly under the guidance of a physical therapist are recommended afterwards though, so full recovery takes about 6-8 months in that sense (but that doesn't mean you will not be active for that long, you should be back to most normal activities after 3 months - if not physically strenuous can resume work).
Let me know if I can further assist you.
Read below.
Detailed Answer:
Hello again.
I must say I find your perplexity justified.Judging by the MRI report those fusion levels seem to be just fine, do not cause any stenosis, so I must say I am not that sure about what he intends to clean up really, unless he sees something else than the report. As I said I can agree with surgery for the C4-5 level where there is the compression worry (due to the stenosis by the bulging disc), not sure about such an aggressive approach. So I would discuss that with him again.
As for recovery times it depends by what one means by that. The time for the fusion itself to happen, to merge together, is 3 months. Exercises programs possibly under the guidance of a physical therapist are recommended afterwards though, so full recovery takes about 6-8 months in that sense (but that doesn't mean you will not be active for that long, you should be back to most normal activities after 3 months - if not physically strenuous can resume work).
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again for the quick reply, I guess maybe the following results from a CT Scan "The CT scan results were: Prior discectomy and fusion from C5-C7. Callus or osteophyte continues to narrow the spinal canal. Facet and uncovertebral joint hypertrophy result in persistent neural foramina narrowing." is what the doctor is worried about. I am not sure what callus or osteophyte is exactly and why it is narrowing the spinal canal at C5-7 which were fused already?
Brief Answer:
Read below
Detailed Answer:
Sorry for the late answer, had a very busy start of the week at the hospital and couldn't manage the time.
It is true that the CT report speaks of osteophytes narrowing the spinal canal, but usually between a CT and a MRI, the MRI is regarded as the more accurate exam in evaluating canal stenosis, so I gave my opinion based on the MRI report. So while the CT report makes the decision to interven on those levels more understandable, I still would be reluctant to operate on those levels with that MRI report. If the MRI report had sounded inconclusive (which may happen due to the metallic artefacts) I'd have understood, but the MRI report doesn't mention anything of the kind and states there is no stenosis.
As for what osteophytes are, they are bony spurs created over the years, part of the arthritic changes taking place in the spine. Whether they cause any symptoms depends on the direction they grow, whether they cause any compression or stenosis. So if growing in the direction of the spinal canal they can cause stenosis. It is something which is not solved by fusion, fusion deals with the intervertebral disc as another cause of stenosis, not with the osteophytes which can continue to develop whether a fusion is successful or not and may require surgery.
I hope to have been of help.
Read below
Detailed Answer:
Sorry for the late answer, had a very busy start of the week at the hospital and couldn't manage the time.
It is true that the CT report speaks of osteophytes narrowing the spinal canal, but usually between a CT and a MRI, the MRI is regarded as the more accurate exam in evaluating canal stenosis, so I gave my opinion based on the MRI report. So while the CT report makes the decision to interven on those levels more understandable, I still would be reluctant to operate on those levels with that MRI report. If the MRI report had sounded inconclusive (which may happen due to the metallic artefacts) I'd have understood, but the MRI report doesn't mention anything of the kind and states there is no stenosis.
As for what osteophytes are, they are bony spurs created over the years, part of the arthritic changes taking place in the spine. Whether they cause any symptoms depends on the direction they grow, whether they cause any compression or stenosis. So if growing in the direction of the spinal canal they can cause stenosis. It is something which is not solved by fusion, fusion deals with the intervertebral disc as another cause of stenosis, not with the osteophytes which can continue to develop whether a fusion is successful or not and may require surgery.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
