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Suggest treatment for spinal canal stenosis

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Posted on Fri, 11 Jul 2014
Question: The MRI of my C-spine results are back...
At C4-5, C5-6, C6-7 there is generalized disc-osteophyte complex with mild central spinal ca stenosis and mod. severe bil. neural foraminal stenosis.
At C6-7 the AP diameter of the spinal canal measures 6.6mm at this level and there is effacement of the CSF, as well as flattening of the ant. contour of the cord, suspicious for mild mass effect. There is a subtle, focal increase in T2 signal within the left ant. aspect of the cord just below this level, questionable for possible edema within the cord. There is also bil. Neural foraminal stenosis.
I am 66, a retired nurse and have neck discomfort of several yrs. Over the past 1 1/2 months I have had pain at the C7-T1 area that has caused a knife-like sensation when I extend my neck. I have also had transient tingly sensation over my C4-5 dermatone regions. This has gotten considerable worse over the past 2 weeks. I have no weakness of my R hand/arm and my reflexes are apparently normal though the Dr. wondered if my supination reflex was sl. diminished. As yet I have no neuro consult.
I also have O-A of my feet, hands, L knee. I have had a R total knee replacement 9yrs.ago.
From this report, I am thinking a neurosurgical consult would be appropriate?
The radiologist has recommended a repeat MRI in 6 mon.
I wonder what your take on these results is.
Thanks so much for your expertise!
XXXX
doctor
Answered by Dr. Jose Ignacio Artero Munoz (1 hour later)
Brief Answer:
Neurosurgeon

Detailed Answer:
Hello,

Delighted to be able to help.

Consult with a neurosurgeon is the most appropriate in this situation. Spinal canal stenosis and moderate-severe bilateral neural foraminal stenosis are reasons to go to the neurosurgeon.

If you do not have symptoms, it would be possible expect and repeat MRI in 6 months but the findings of MRI combined with symptoms (pain.tingling ....) it is advisable to consult a neurosurgeon because a surgical intervention maybe necessary. However say that surgery is currently with minimal surgical incision and less discomfort after surgery.

I hope I have answered your query. If you have any further questions I will be happy to help.If you do not have any clarifications, please don’t forget to evaluate my answer. I wish you good health.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jose Ignacio Artero Munoz (9 hours later)
Thank You Dr. Munoz,
I do have some questions ...
Does "effacement of the CSF" mean that the CSF is not visible on the MRI slice at the C6-7 level?
I will have a wait list time in order to be seen by a neurosurgeon. Is there any danger of this progressing and causing permanent cord damage from C6-7 level down the cord?
How serious is this condition both with the central canal stenosis and also the mild mass effect, the possible cord edema and the effacement issue?
Can you explain the "Focal increase in T2 signal within the L ant. aspect of the cord just below C6-7 level ........ I have no idea what this means.
I am wondering if I might need a C6-7 discectomy and fusion?
I didn't mention in my initial MRI results....disc height loss is appreciated at C4-5, C5-6, C6-7 in keeping in degenerative disc disease. Disc height loss is most severe at C6-7.
Thanks again for your expertise!
XXXX

doctor
Answered by Dr. Jose Ignacio Artero Munoz (6 hours later)
Brief Answer:
Neurosurgeon

Detailed Answer:
Hello,
Delighted to be able to help.
About your questions:
1.-CSF is visible on the MRI at C6-C7 level but the visibility is worse due to Spinal canal stenosis.
2.-Initially,in short therm,there is not danger of progression and causing permanent cord damage from C6-7 level down the cord.
3.-About seriousness of lessions,are injuries likely to require surgical intervention.
4.-About"Focal increase in T2", when exists focal increase,it can be caused by infection, tumor ... but in this case focal increase is due to edema.
5.-C6-7 discectomy is a possible treatment,you should not worry, it is a common procedure in Neurosurgery.
6.-C4 to C7 findings are suggestive of herniated discs at that level.
I hope I have answered your query. If you have any further questions I will be happy to help.If you do not have any clarifications, please don’t forget to evaluate my answer. I wish you good health.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Jose Ignacio Artero Munoz (15 hours later)
Thanks for your quick response Dr. Munoz,
I think you have answered my questions and I understand your responses.
I will mull this over and hopefully see a neurosurgeon before too much time passes.
If I have any further questions, I will forward them to you.
Sincerely,
XXXX
doctor
Answered by Dr. Jose Ignacio Artero Munoz (6 hours later)
Brief Answer:
Neurosurgeon

Detailed Answer:
Thanks to you.
A pleasure to answer your questions.
If you have any further questions I will be happy to help.If you do not have any clarifications, please don’t forget to evaluate my answer. I wish you good health
and good luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Jose Ignacio Artero Munoz

General & Family Physician

Practicing since :2001

Answered : 1118 Questions

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Suggest treatment for spinal canal stenosis

Brief Answer: Neurosurgeon Detailed Answer: Hello, Delighted to be able to help. Consult with a neurosurgeon is the most appropriate in this situation. Spinal canal stenosis and moderate-severe bilateral neural foraminal stenosis are reasons to go to the neurosurgeon. If you do not have symptoms, it would be possible expect and repeat MRI in 6 months but the findings of MRI combined with symptoms (pain.tingling ....) it is advisable to consult a neurosurgeon because a surgical intervention maybe necessary. However say that surgery is currently with minimal surgical incision and less discomfort after surgery. I hope I have answered your query. If you have any further questions I will be happy to help.If you do not have any clarifications, please don’t forget to evaluate my answer. I wish you good health.