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What Does "right Sided Foraminal Stenosis" In An MRI Indicate?
Question: These are the results from my MRI in follow up to my last enquiry.
Lumbosacral Spine.
Right sided foraminal stenosis of high grade at L4/5 level with impingement of right l4 nerve root
And the cervical MRI --
2 cord lesions,to the left of midline.Focal area of hyperintensity involving the left side of the cord,behind the c2 vertebral body just above the c2/3 disc ,measuring 4 mm in diam and 10 mm in length .there is further hyperintensity involving the left side of the cord ,15 mm in length and 4 mm in diameter.
What is your treatment opinion
Lumbosacral Spine.
Right sided foraminal stenosis of high grade at L4/5 level with impingement of right l4 nerve root
And the cervical MRI --
2 cord lesions,to the left of midline.Focal area of hyperintensity involving the left side of the cord,behind the c2 vertebral body just above the c2/3 disc ,measuring 4 mm in diam and 10 mm in length .there is further hyperintensity involving the left side of the cord ,15 mm in length and 4 mm in diameter.
What is your treatment opinion
Brief Answer:
My reply is below.
Detailed Answer:
Hi,
Thank you for getting back.
I have noted your MRI lumbosacral and cervical spine findings.
In the lumbar MRI, there is disc bulge with pressure on one of the nerves. This would get better with medications such as pregabalin or gabapentin, and physiotherapy (back extension exercises).
The cervical MRI suggests a recurrence of ADEM. So, we need to start immunotherapy. In the acute phase, a dose of steroids-methylprednisolone 1 gram daily for 3-5 days is usually given.
After this depending on the severity of illness (symptoms), further treatment may include plasmapheresis, IVIG or cyclophosphamide.
There is no need to worry as you would get better with treatment.
I hope it helps. Please get back if you have any follow up queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
My reply is below.
Detailed Answer:
Hi,
Thank you for getting back.
I have noted your MRI lumbosacral and cervical spine findings.
In the lumbar MRI, there is disc bulge with pressure on one of the nerves. This would get better with medications such as pregabalin or gabapentin, and physiotherapy (back extension exercises).
The cervical MRI suggests a recurrence of ADEM. So, we need to start immunotherapy. In the acute phase, a dose of steroids-methylprednisolone 1 gram daily for 3-5 days is usually given.
After this depending on the severity of illness (symptoms), further treatment may include plasmapheresis, IVIG or cyclophosphamide.
There is no need to worry as you would get better with treatment.
I hope it helps. Please get back if you have any follow up queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have been advised that a High grade stenosis with impingement will require surgery and that the hyper intense lesions in the C/spine require follow up.
What is your opinion??
Also The demyelination has not increased since the original ADEM where it was first noted so is it reasonable to say that this is still caused by the original ADEM.
What is your opinion??
Also The demyelination has not increased since the original ADEM where it was first noted so is it reasonable to say that this is still caused by the original ADEM.
Brief Answer:
My reply is below.
Detailed Answer:
Thank you for getting back.
Yes, I agree that high grade stenosis with impingement of nerve may require surgery in about 30% people. However, it would be useful to give conservative treatment a chance, as about 50-70% people may get better with that. I only say this because of morbidity associated with surgery.
Regarding demyelination, if the cervical cord lesions are old (as seen in previous MRIs) and there are no new symptoms correlating with that, it would be good to wait & watch.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
My reply is below.
Detailed Answer:
Thank you for getting back.
Yes, I agree that high grade stenosis with impingement of nerve may require surgery in about 30% people. However, it would be useful to give conservative treatment a chance, as about 50-70% people may get better with that. I only say this because of morbidity associated with surgery.
Regarding demyelination, if the cervical cord lesions are old (as seen in previous MRIs) and there are no new symptoms correlating with that, it would be good to wait & watch.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The pain in my neck is quite severe,radiating into my right shoulder and often numbing right to my fingers, these symptoms have only recently occurred but are extremely debilitating are the focal areas of hyperintensity likely to be rectified with surgery also
Brief Answer:
Hyperintensity would not get rectified by surgery
Detailed Answer:
Hi,
Thank you for getting back.
As per the MRI, stenosis is in the lumbar (lower back) region and the surgery would have advised for the lower back. There is no stenosis in cervical region, as per the report.
Cervical cord hyperintensity would not get rectified by surgery.
For your current symptoms, you should start pregabalin or gabapentin capsules.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Hyperintensity would not get rectified by surgery
Detailed Answer:
Hi,
Thank you for getting back.
As per the MRI, stenosis is in the lumbar (lower back) region and the surgery would have advised for the lower back. There is no stenosis in cervical region, as per the report.
Cervical cord hyperintensity would not get rectified by surgery.
For your current symptoms, you should start pregabalin or gabapentin capsules.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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