What do these MRI images of cervical spine indicate?

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Posted on Fri, 19 Jun 2015 in General Health
Question: I would like you to take a look at all of scans and let me know if you see progression. I was in a car crash recently (Eleven weeks ago). I would be most grateful if you could review these scans. I am seeing a physiotherapist. My symtoms are severe pain in both arms of a stiffness nature (like having two needles in the arms) and shoulder blade and upper back pain. I would be most grateful if you could review..is there central canal stenosis and is this curable...thanks
doctor
Answered by Dr. Erion Spaho 30 minutes later
Brief Answer:
Cervical canal stenosis seems stable.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

I examinated carefully the MRI images of your cervical spine too.

There is cervical canal stenosis (moderate) at C5-C6 level with compression of the medula.

The stenosis seems stable (not progressing) at different time imaging studies.

Treatment should be guided by your symptoms and neurologic findings correlated to imaging studies.

Another thing to evaluate is any instability at C5-C6 level, for this purpose plain radiographs of your cervical spine at flexed and extended position are needed.

If there is instability, decompressive and fusion surgery needed to prevent further spine damage.

If your symptoms are worsening and significant neurologic deficits such spasticity, walking constricted, urinary problems, you should have surgery (decompressive with or without fusion) in order to prevent progress of symptoms and relieve actual symptoms too.

If there is improvement of symptoms, you should continue physical therapy.

I suggest you to discuss with a Neurosurgeon above mentioned issues.

Hope this helps. If you have further questions and clarifications, feel free to ask, if not, you can close the conversation and rate the answer.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 39 minutes later
Thank you for your reply. My surgeon states all three scans remain the same..hence I had another scan done recently as I had a car crash in March.
My spine surgeon thinks that things should settle down. He states it is too close to the crash to intervene and does not think it is too bad. I attend physiotherapy and get tested neurologically every week. When you say compression of the medulla.. do you mean the spinal cord..is this not very dangerous..i have very sore limbs meaning arms (upper) and soft tissue pain from accident. Do you see a whip lash. Is this surgery safe..i have no weakness, my walking is fine.. the only problem is stiffness.. can this settle down..is the stenosis all over the neck.thanks for all your help
doctor
Answered by Dr. Erion Spaho 1 hour later
Brief Answer:
Stenosis located only at one level.

Detailed Answer:
Welcome back.

Yes with medula I mean spinal cord, sorry for the terms.

Cervical soft tissue pain is due to whiplash.

Having neurologic deficit only in arms means there was central spinal cord damage from accident.

Stenosis is located only at one level, not all over.

If mild symptoms, conservative treatment is tried first aiming to reduce pain and strengthening neck muscles by NSAID drugs use and physical therapy.

If worsening of symptoms, surgery is indicated. This type of surgery consists on decomprression of spinal cord and nerves, it is safe with minimal risks.

Hope this helps. Wishing you good health.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 46 minutes later
Thanks..
The Arm pain (squeezing) had started prior to accident. Can you see a difference between the Scan in February 2015 and the Scan in May..2015....you mentioned you did not see any progression.. this accident was only recent.. my physiotherapist thinks it is just whiplash.. my surgeon is saying there is little difference....is the protrusion on the spinal cord or the theracal sac...I have no numbness, no muscle weakness.. just stiffness in arms..which is obviously coming from the neck ..thanks ..
doctor
Answered by Dr. Erion Spaho 35 minutes later
Brief Answer:
This condition doesn't get better by itself.

Detailed Answer:
Hi again XXXXXXX

Differences between MRI's February-May 2015, are only minor ( disc is compressing thecal sac a little bit more), important thing are your symptoms.

Since there's only spasticity, there is no need for now, to undergo surgery.

This condition doesn't get better by itself, but can stabilize with physical therapy and NSAID drugs.

If these measures fail to improve your symptoms, surgery should be considered.

Hope this helps. Best regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Erion Spaho 35 minutes later
Thanks very much...for your prompt reply
Are you saying that the May scan is worse than the February scan.
Do you think that the arm symtoms could settle..
How long should I give prior to surgery?
How does the disc look? I guess I should ask my surgeon to scan it as you have mentioned.
Do you this disc compressing thecal sac more to the right or to the left..
is the stenosis caused by the herniation
is it a big herniation
Could the pain be caused by the whip lash
How would you know if you had nerve tissue damage from a whiplash
Do you see any damage to ligaments on the scan
If I was to undergo surgery.. would this be fusion or decompression surgery or both
would an injection be of any benefit .. the arm pain only comes on movement..
there is no muscle weakness
Are all the other discs ok
thanks for all your valuable help
XXXX
doctor
Answered by Dr. Erion Spaho 5 hours later
Brief Answer:
Surgery timing is guided by symptoms evolution.

Detailed Answer:
Hello again XXXXXXX

The disc that causes cervical stenosis at C5-C6 level compresses more at the right side, explaining right arms symptoms.

There is moderate stenosis at this level, because there is still cerebrospinal fluid around spinal cord.

Whiplash results in soft tissue pain of the neck. There seems to be no serious traumatic damage to neck soft tissue in MRI.

Need for surgery and timing is guided by your symptoms evolution, neurologic findings correlated to imaging studies findings, so there is no exact time for surgery.

In general, conservative treatment is tried for a couple of minutes, before deciding about surgery.

If the stenosis and whiplash will stabilize, then arm symptoms should stabilize too.

Hope I helped you. Best regards.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Erion Spaho 3 hours later
Many thanks.. is cerebrospinal fluid in all the scans..?
would you be able to advise on what type of surgery they would recommend?
Is the fact that all of this is so close to the spinal cord dangerous...
The crash was two months ago.. I did get a right tough bang..
My surgeon does not want to do anything as he thinks that all should settle down in time...I did have issues with the L4L5 disc before and all settled.
I found you extremely helpful. I like to understand everything.
Thanks
XXXX
doctor
Answered by Dr. Erion Spaho 3 hours later
Brief Answer:
Detailed explanation below.

Detailed Answer:
Hi again XXXXXXX

Don't worry about cerebrospinal fluid, its presence around the spinal cord means there is more space left by compression.

There is cerebrospinal fluid all over your spinal cord and this is good news.

If you were my patient, in case if worsening of symptoms, the surgical procedure I would recommend is the anterior cervical discectomy and probably fusion.

This is a minimally invasive surgical procedure and is suitable for one level stenosis and herniation of cervical spine.

In your case, I agree with your Doctor, conservative treatment possibilities should be exhausted first to treat your condition.

If they fail in improving symptoms, then surgery is indicated.

Hope I've been understandable. Best regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Erion Spaho 2 hours later
Many thanks..a few quick question:-
Is stenosis always present for herniations?
Is my herniations a severe one?
Are there any statistics available for prognosis of this condition..hence are surgical procedures very common?
Would you advise me to get that disc C5C6 scanned at flexed and extended positions
Thanks so much
XXXX
doctor
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
Your herniation is a moderate one.

Detailed Answer:
Hi again XXXXXXX

Disc herniation doesn't always cause spinal cord stenosis, usually stenosis from herniated disc happens when there is a narrow spinal cord canal, or massive herniations.

Most of herniated disc diseases (about 80 %) are treated successfully conservatively.

The remainder are treated surgically with very good results.

These surgical procedures are very common in spine surgery.

Plain radiographs in flexed and extended position is done to evaluate instability of vertebrae and vertebral column.

Hope I helped. Best regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3793 Questions

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