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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does my scan test report indicate?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Mon, 6 Jun 2016 in Headache and Migraines
Question: Can you have a look at my scan please and let me know what you think from a neurological point of view. Thanks..i just had an injection on the left side.pulse radio frequency.. thanks..all levels c1 to c8.. ..is this safe...is my scan near the spinal cord and is it very bad
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

The scan shows the disc protrusion to be near the spinal cord I am afraid, it impinges on it to use the same term as the report. Fortunately it doesn't speak of other signs of cord suffering from it such as edema, demyelination, atrophy or syringomyelia. So in itself it doesn't warrant surgical intervention if no other cord compression signs.

It must be correlated to neurological examination though, which should search for signs of myelopathy, spinal cord damage. Common symptoms are weakness, heavy feeling of the limbs, difficulty performing fine motor skills (such as writing, wearing etc), with signs like brisk increased reflexes, appearance of abnormal pathologic reflexes in the limbs, increased muscle tone, gait changes. If such signs appear then surgery to relieve spinal stenosis might be considered.

If no such signs, then management remain through physical therapy and over the counter NSAID painkillers. Pulse radio frequency treatment is more useful for nerve compression, doesn't help much with cord compression.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 13 minutes later
Many thanks..can you see the previous scans on this site which is related to may..the scan you have read is the most updated one,, in February..is the disc protrusion bigger than the scan in may,..how would you know if you had spinal cord damage..i have heavy feeling f the limbs bilaterially..upper arms is there spinal stenosis?..would a nerve blaock at c5c6 be better for me,..i am due to have a nother pulse radio frequency in three weeks time on the right side..is it nerve compression i have.. i did not think it was so close to the cord..surely this is very dangerous..any other suggestions on injections..the heaviest on the limbs is desperate.thanks


i had a nerve conduction study last year and all was clear..thereis no weakness..just heaviest i the limbs and upper back spasms and shoulder pain
doctor
Answered by Dr. Olsi Taka 33 minutes later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

I reviewed the May scan and I do not believe there is any advancement of the cord compression, the degree of impingement looks the same, the protrusion is not bigger. So you shouldn't see it as that dangerous, even if it advances it would be very very slowly giving you time to intervene.

As for knowing if there is cord damage as I said that is based on the combination of imaging signs which I mentioned (edema, demyelination, atrophy or syringomyelia) which are not visible and physical signs (reflexes, tonus, walking, strength) which unfortunately can't be evaluated in this virtual setting, heavy arm feeling may be a sign, but is not enough as it is subjective, the whole exam is needed.

The nerve block is useful for nerve compression, if there is pain radiating from the neck down your to your thumb. The pulse radio frequency is useful for the nerve compression as well, not for spinal cord, as I said only physical therapy. Unfortunately due to the chronic changes to your column, you are bound to be more sensible to strain on the column, with inflammation leading to some episodes of spasms and pain.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 12 minutes later
Many thanks for your very clear answer. You are very clear.
I am wondering if I am wasting my time having another radio frequen. injection on the right side..i have just had left side..c1 to c8..it is still sore but it is only one week,,is there any nerve root compression at all..is there stenosis..will the injections help the nerve root problem. what injection would you suggst..there is an osteophyte there too..what would happen if i was offered surgery .would this help..it has taken me a long time to decide on injetion intervention ..my walk and all neurological signs are fine..only probelm i have is pain when lifting, pushing, driving..all puts pressure on the nerves..i get physio every week..is this very bad problem and could i end up disabled
doctor
Answered by Dr. Olsi Taka 6 hours later
Brief Answer:
Read below.

Detailed Answer:
Hello again.

I don't think the radio frequency therapy is wasted, I just meant that it is not done for the spinal cord impingement in itself. The pain you have is not by that impingement on spinal cord, even if that was to progress it wouldn't manifest with pain but with impairment of motor functions. The pain is due to the inflammation all along your spinal column leading to pain signals to the nerves. Radio frequency aims precisely at stopping those nerves from sending pain signals. I don't know how effective it will be in your case, its efficacy is not the same in all patients, but it is a valid treatment option when over the counter pain killers and physio is not enough. Surgery is reserved for when there is a nerve root compression (with the pain irradiating in the arm I described and nerve suffering on nerve conduction studies) - not for the widespread muscle spasms you mention), or when there is evidence of cord suffering from compression with impairment of motor functions I mentioned.

As for ending up disabled, if you mean due to spinal cord compression and motor impairment I do not see that happening in a near future as your repeat scans do not show much progression. As for over the years in a distant future, the vertebral column undergoes degenerative changes in each of us with age. The pace of that happening depends on several factors such as heavy physical work, trauma and ultimately genetic factors. So if as I am assuming you will avoid the first two, genetic factors are at play as well can't be predicted. We can't change them, what we can do is try to keep the load and straining on the vertebrae as low as possible, that is why I keep mentioning physiotherapy, I know it doesn't relieve the pain just like that, but is the only means of enabling muscles to better support the spine.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 14 hours later
Many thanks.. you have been extremely good and thanks so much for this every explicit answer..very very clear..can you see any of my other neck scans..there were earlier one s there on the system.. i would like you to review if possible to check for progression..i still have alot of spasm on my left side after the injection pulse radio frequency... i get physiotherapy every week.i try so hard to avoid physical work
i wonder if you could be ever so kind as to review my most recent lumbar spine scans.. you will see it on the system.. also it is worth getting a scan done for the bones. also could you clarify..is there spinal stenosis in the neck and is surgery successful.. thanks so much for all your help
doctor
Answered by Dr. Olsi Taka 40 minutes later
Brief Answer:
Read below.

Detailed Answer:
The scans that I am able to see are those of May 2015 and February 2016, as I said I do not see any progression between them. I am not sure whether you mean earlier scans, I do not see those.

The lumbar scan shows similar degenerative changes in the lumbar spine (it is common for neck and lumbar changes to go hand in hand as the most XXXXXXX parts of the spine). More marked these changes are at the L3-L4 and L4-L5 levels, with more marked compression on left L3 root.

As for whether there is stenosis in the neck, stenosis is just a latin word for narrowing, so naturally there is some narrowing since there is disc protrusion. As for the diameter though it can not be measured in the pdf format which you have used. Normal diameter is around 17-18 mm, 10-13 constitutes relative stenosis (depending on neck position), less than 10 is absolute stenosis. As I said can't measure it, but the impression by the pdf is that the narrowing doesn't require surgery for the moment. While in contact with the cord doesn't compress it, so I do not think surgery would be of benefit for that purpose, only if there is compression with the signs I mentioned earlier. It is in that case that timely surgery is successful, not in the case of neck spasms.
In the future I suggest not to change images, leave them as they are. The preferred method is to find in the disc the folder called Dicom (it contains the images), zip it in a single file, upload it to some file sharing service like dropbox and simply put the link in the query. That way we have the images at our disposal unchanged and through Dicom software can make measurements, compare side by side etc, much easier and productive for us than the pdf method.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 58 minutes later
many thanks..do you think that the back will need surgery and is there is lateral stenosis.
also one of the reasons i had the injection (on the left side was for needle like heavyness pain in the upper arm..i do not have pins and needles.would pulse radio frequency injection at all levels be necessary for all that.would a nerve block for c5c6 be better..the injection does not seem to have worked.. it is one week..there is still bruising and tenderness at the site of the injection. are these injections dangerous..pain is my worse problem,,it is all around the front of the neck, and upper arms and shoulders and scapular..is it safe to be driving.. will this make the situation worse..i try to keep as XXXXXXX as possible..i go to the gym everyday and do low impact exercises..the pain when pushing, pulling is dreadful..thanks for all your help and also for reviewing all my scans


i meant to ask is a regular facet injection a better injection. would it be more effective


i uploaded the earliest scan for the neck thanks..2012
doctor
Answered by Dr. Olsi Taka 15 hours later
Brief Answer:
Read below.

Detailed Answer:
Sorry for the late answer.

Surgery may be needed for the lumbar issue (L3 root compression) based on the imaging results. However imaging is not everything, there are cases with seemingly nerve compression which do not have marked symptoms. So surgery is done in cases with correlation between compression on imaging and corresponding symptoms which are not responding to conservative therapy even after several weeks.

You shouldn't hurry into dismissing efficacy or not of radiofrequency treatment. It may take some weeks, a real evaluation will need 3-4 weeks of time. As for risks they are minor, some pain and tenderness over the first few weeks but are temporary.

As for which is more between radiofrequency or injections, that varies among patients, in some patients one method is more effective than others, that is why there are more than one alternatives in place, because there is not one single option better for all patients. Also at times it depends also on the performing physicians experience and expertise with on method or the other.

However I wouldn't consider facet injections right now so soon after the radiofrequency, can't jump from one procedure to the other so soon.

I viewed the other scan (it says 2014 not 2012). It is not complete though, there are no sagittal views (the views from the side where we can view all the vertebrae), again it would be better if you uploaded using the method I mentioned above rather than these PDFs, I believe might be even easier and quicker for you. Based on the axial (horizontal) views, I would say it's pretty much unchanged from back than to now. The other scan is from October 2015 which I had already seen, along with May 2015 and February 2016.

Looking forward to hearing from you again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 4 hours later
Many thanks for your very detail mail. This is very explicit and reassuring.
I really appreciate all this.
Do you think it is safe to continue activities at this stage after the injections.. i use the zacuzzi alot.. could this effect the injection in any way..seems abit agraved still but is is only a week..is a nerve block a more invasive procedure. the nerve root compression is fairly bad..needly feeling in the arms..not going into hands.should activities be restricted? Alittle bit of a concern.
The back has settled via epidurals..do you evidence of lateral stenosis..
also are all the other discs ok in the neck.. what type of surgery would you be thinking of for the back..thanks.you are very helpful and knowledgeab
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below.

Detailed Answer:
Thank you for your appreciative words.

Sorry I forgot to address your driving question before. You can drive for short periods, try to avoid long trips as by stain with the spine erect there is more load on your spine. The same applies for other activities which may include prolonged sitting or standing, those are the activities to be avoided (as much as possible). Jacuzzi shouldn't do any harm.

In terms of invasivity, nerve block is not much more invasive then the radio pulse method. They both involve inserting a needle near the nerve, afterwards in one method drugs which anesthesize the nerve and lower inflammation are injected, in the other method radio waves are delivered by the needle to the targeted nerve.

The changes to the other discs in the neck are minor, but the spine has lost its normal curvature. That means that other levels are exposed to more stress than normal as well and there is a higher likelihood to have changes in the distant future, hopefully physio will prevent that.

As for the surgery for the back that usually consists in microdiscectomy, removing the disc portion compressing the route, however that is appointed by the surgeon, he knows the route he will deem more appropriate not the neurologist. But if the epidural has worked you shouldn't be hurrying towards surgery, only if symptoms reoccur.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 1 hour later
thanks for this...do you think it was wise to do all of the discs radio frequency wise..also what is the procedure radio frequency ablavation..could the injection of irrated things..also the other side is acting up quite abit..is there anyway of reversing the curvature..thanks so mcuh
doctor
Answered by Dr. Olsi Taka 17 minutes later
Brief Answer:
Read below.

Detailed Answer:
Not all the discs are always done, but if it is difficult to locate one single originating level, if there is pain and muscle spasm with tenderness on palpation on all facet levels then the procedure may include many levels. So nothing unwise about that, given that other conservative measures had failed it was a good alternative to try.
Terms like radio frequency ablation, pulse radio frequency, rhizotomy etc indicate the same procedure principle, inserting the nerve under c-ray guidance near the nerve which conveys the pain signals from the facets, then through an electrode heat waves, pulses, are sent to those nerves, artificially damaging them and preventing them from sending pain signals.
As I said before it is common to feel some soreness and the pain doesn't subside right away, needs several weeks. So do not be alarmed for having still pain. As for the other side, there is no reason for it to be affected, perhaps due to muscle spasms.
The curvature is not reversible I am afraid, it is part of all these degenerative changes which have happened over the years, accelerated by the accident, so it is a chronic issue which can not be reversed.

I hope your symptoms will respond to radio treatment soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 50 minutes later
does the radio frequency procedure burn or nerve ..it was pulsed..does this not make a difference..thanks so much..also the right side is bad.. how long do you think i should give to get that side done..thanks so mcuch
doctor
Answered by Dr. Olsi Taka 14 hours later
Brief Answer:
Read below

Detailed Answer:
In previous years the radiofrequency procedure did "burn" the nerve fibers. Now in recent years with the electrical current being pulsed much less heat is generated and the nerve fibers are more stunned than destroyed, so yes the fact it is pulsed makes a difference (a good kind of difference - less invasive).

As for the right side I would wait for about 4 weeks, which gives also the time to evaluate the outcome of the procedure on the left side.

Do not hesitate to let me know if you have more inquiries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 22 hours later
just a quick question..is there a chance of any brain damage with a pulsed radio injection..i always fear these injections as they are so close to the brain.. my physio mentioned something yesterday..the sight of the injection is still very sore..is this normal..this was the first injection i ever had for the neck..thanks so much
doctor
Answered by Dr. Olsi Taka 5 hours later
Brief Answer:
No risk of brain damage.

Detailed Answer:
No, there is no risk at all for brain damage, the brain is not that near, it is up in the skull. The procedure is done under x-ray guidance in any case, but it really is far not only from the brain but from the spinal cord as well.

As for the soreness, as I said some soreness can be expected, in some people it lasts less in some more, for 1-2 weeks. Reason to be concerned would be if the soreness is on an increasing curbe, if it is decreasing, even if slower than one would wish, then do not think you should worry.

Wishing you'll feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 4 hours later
many thanks...you are excellent... out of interest.. is the disc very badly protruded and is it towards the spinal cord..also.. i had a bad accident last year like a crush injury in the neck.. could this be causing the dreadful spasms in the neck and the needly feeling in the arms..
doctor
Answered by Dr. Olsi Taka 16 hours later
Brief Answer:
Read below.

Detailed Answer:
Sorry for the late answer.

The protrusion is considerable, but it could be worse if as I said if compressed the spinal cord. It protrudes centrally towards the spinal cord and to the right.

I am aware of your bad accident. Yes of course it is a factor. Causes of degenerative changes in the spines are genetic predisposition, trauma (accident) and heavy physical work. So accident is a factor, most likely there were already some chronic changes before, which were later accelerated by the accident. As a result of there is inflammation of the joints leading to muscle spasms and pins and needles due to irritation of the nerves by the inflammation.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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