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What does the follwoing MRI scan of cervical spine indicate?

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Neurologist
Practicing since : 1988
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Hello Doctor,

Thank you very much for your follow up on my brothers recovery. My brother seems to be in the process of recovery. But so far there is no significant recovery occured. We were kind of concerned about his recovery.

I got an X-Ray report which was taken on the next day of the accident took place. Could you please go through the X-Ray report and MRI Scan report again and answer my questions below? He is now undergoing physiotherapy regularly.

Once again my sincere thanks for your follow up. Your answers really helped me understanding my brothers situation.

MRI Scan result:
DEPARTMENT OF RADIOLOGY

MRI - CERVICAL SPINE – REPORT

* Screening MRI study of Cervical in axial & sagittal T1 W , T2 W & STIR sequences.
* Traumatic disc extrusion with T2 W hyperintensity noted in C6-7 causing compression on theca,
spinal cord with focal spinal canal stenosis of (9 mm ) with B/L neural foraminal narrowing.

* Gr - I Subluxation of C6 over C7 Vertebra
* T2 W & STIR altered signal noted in posterior paravertebral muscles (Lt > Rt )

* Suspicious focal T2 W altered signal noted in cervical spinal cord at C6, C7 vertebral level.
* Rest of the Vertebral bodies are normal in height contour and signal intensity.

* Rest of the intervertebral discs is normal in intensities.
* Rest of the Spinal cord & Thecal sac reveal normal in signal intensities.

IMPRESSION:

** Gr - I Subluxation of C6 over C7 Vertebra
** Traumatic disc extrusion with T2 W hyperintensity noted in C6-7 causing compression
on theca, spinal cord with focal spinal canal stenosis of (9 mm ) with B/L neural
foraminal narrowing.
** Suspicious focal T2 W altered signal noted in cervical spinal cord at C6, C7 vertebral level
- Likely Cord Contusion.
** T2 W & STIR altered signal noted in posterior paravertebral muscles (Lt > Rt )
- Intramuscular Oedema
- To R/o Posterior vertebral element fracture.

My Brother recovery status:
1. He is now sitting on the wheel chair with assistance of somebody.
2. He is now feeling sense when urinating, and motion but he could not get control over urinating and motion.
3. He is feeling lot of pain on all over his lower part of the body till his feet. and the extent of pain is unbareble
4. He is now able to point out the part name exactly where ever we touch on his body like exact finger of his feet, exact portion of his both the legs


With the progress he is making, MRI Scan and the X-Ray attached in mind, Could you please answer my questions below?

1. Is he on the right direction of recovery?
2. Is there a possibility that he can walk on his own?
3. Could you please let me know if you have seen any people with the same condition as my brother recovered and is able to walk on their own?
4. If there is a possibility that he can walk with the help of stick?
5. With the pace of progress he is making may i know if he can start practice walking in the next couple of months?
6. He is not feeling like eating and he is eating very less quantity of food. Does it impact his recovery?
7. with the progress he is making may i know to what extent he may recover?

Thank you very much for your kind follow up on my brother's recovery doctor.
Posted Wed, 27 Aug 2014 in Brain and Spine
 
 
Answered by Dr. Dariush Saghafi 15 hours later
Brief Answer:
Recovery ongoing- Continued Patience necessary

Detailed Answer:
Thank you for directing your f/u questions to my attention. I truly appreciate the confidence you had in my last set of responses and I will do my best to answer these truthfully and efficiently. Let's just take a quick look back though to remember that when last we conversed I believe your brother was approximately 7-10 days out from the accident. And so that was about the middle of July. We are now at 3 weeks since that time...so all said and told...your brother is approximately 1 month out from his accident,correct?

The MRI images you've provided are exactly the same as I reviewed before and for which you kindly provided the radiologist's report. I once again looked the films over meticulously and made sure I saw and agreed with the findings. I do. However, essentially, this is not a follow up scan of any sort so it really doesn't help me answer your questions any more compared to what we had previously discussed.

Have they obtained any follow-up scans? If not, I wouldn't worry because his clinical progress is more important than what can be seen on scans. It is usually the case that a patient's clinical picture can be several weeks AHEAD of what his scans may show. In other words, at times it is almost NONPRODUCTIVE to look up follow-up scans which can make things appear worse than they really are since there is this "LAG TIME" in how things change in pictures vs. what patients can actually do.

You say that now your brother is sitting with assistance and also able to localize touch sensations. This seems to be ahead of where he was several weeks ago. Obviously, he's still not walking which is of great concern to you. I understand that he doesn't have very much if any voluntary movement in the legs.

And so once again, I can only speak in generalities seeing as how we are so far apart and I have had no opportunity to exam your brother but after looking at his MRI scan again I can say that the cord has suffered some significant traumatic effects from both the subluxation of the vertebral bodies C6/7 in his neck as well as what appears to be some significant soft tissue swelling in the left neck and upper back muscles in the region of where the injury occurred. It is obvious that the VISIBLE injury to the cord itself covers approximately 2 vertebral body lengths which is a large area of nerve damage and swelling that will need to repair itself. This process can be months or longer in duration. Please remember, even though it must seem like an eternity to your family and brother, in reality we're talking about 30 days or so from the time of the accident. This is a very small amount of time when we discuss recovery from spinal cord injuries.

1. Is he on the right direction of recovery?

>>>> Since his condition seems improved as you've described and he is now up and sitting in a chair and has other capabilities of sensation that you've mentioned then, I would answer that YES, he is on the right direction of recovery. Typically, we see sensory function coming back before motor function in these types of traumatic injuries.

2. Is there a possibility that he can walk on his own?

>>>> It is possible that he can walk on his own in the future but there is no reasonable way to predict right now if he is still not demonstrating voluntary movement to any extent in the lower extremities. If and when that occurs he will need to be tested for weightbearing on the legs. At that time it will become more clear what his walking status may be like...but not before.

3. Could you please let me know if you have seen any people with the same condition as my brother recovered and is able to walk on their own?

>>>> I have seen many people with traumatic injuries of the cervical cord recover and walk on their own. Many factors play into a person's recovery such as prior health, SEVERITY OF THE INJURY to begin with, level of attention obtained during recovery, family support systems, etc. Therefore, I must also tell you that I've seen many people with similar injuries remain unable to walk or move their legs after full efforts and physical therapy has been continuously offered. I believe it is still too early to predict what you're asking one way or the other.

4. If there is a possibility that he can walk with the help of stick?

>>>>Since we still don't have an answer to whether or not he will be able to walk then, this question cannot be answered just yet.

5. With the pace of progress he is making may i know if he can start practice walking in the next couple of months?

>>>>> Unfortunately, I cannot give any predictions to this question since we have no movement in his legs yet. Obviously, as time goes on and if movement fails to return then, one can predict less of a chance to walk, however, at 30 days out from accident I believe it is still too early to make such a call.

6. He is not feeling like eating and he is eating very less quantity of food. Does it impact his recovery?

>>>>Certainly, good nutrition and good hydration with fluids is tantamount to his having the best chance of recovery. I believe it's understandable at this point that he feel a little down over what has happened. He is trying to adjust to a lot of things from a psychological point of view since this happened and it doesn't XXXXXXX me that he has less of an appetite than usual. If you feel this mood or loss of appetite may reflect the presence of a severe depression and that may be hindering his recovery perhaps, a consultation with a psychiatrist or psychologist would be helpful to him? I would not be surprised to hear that in your hospital's spinal cord recovery unit there is a person who is assigned specifically to talk and help the patients mentally when necessary. You should discuss this with his primary doctors because I agree that good nutrition is necessary for good recovery.

7. with the progress he is making may i know to what extent he may recover?

>>>> Again, based on everything I've said up to this point I believe my main point would be that he is at most 30 days out from the accident which represents a very small amount of time from an injury that could take months or even years to recover from and that is assuming we are going to see such ambulatory recovery even. I think you've already seen the progress he's making in sensory modalities and even with pain which some people might suggest represents some form of recovery....though I certainly would hope that they can control his pain with medications or something.


In conclusion, my opinion overall is that we are still very early into his recovery phase and that since 3 weeks ago that we last conversed there has been some recovery in some aspects. He is now controlling his trunk enough to sit, able to feel tactile sensations which before he could not, feels himself urinating, and to my way of thinking, BETTER than before. However, motor function remains elusive and I don't have a good answer as to when this will return. Injury to the cord was significant. Perhaps, his doctors will get a repeat scan in a few weeks and if so you may wish to send a copy for me to take another look at but his last scan definite showed an amount of trauma to the cord and the neck/back muscles which was extensive. Time to recovery under these circumstances remains unknown.

If I may add that apparently he hasn't suffered any complications which many people tend to have due to immobility of the legs and that's very good news. You may check to be sure that he is being treated PROPHYLACTICALLY against the possibility that blood clots could form in the legs and travel to his lungs or elsewhere. Generally, we like to place patients of this type into compression stockings all the way to the groin and he may even be receiving a low dose of anticoagulation in order to keep the blood a little thin. Good hydration on his part will also help. You will also want to be sure he is doing his BREATHING EXERCISES which again are very important to overall recovery and avoidance of complications such as pneumonias or other lung infections.

I hope these answers have been helpful although I know not all are what you would've liked to have heard. Also, keep in mind that his doctors who are physically there and treating him have a much better idea of the answers to some of the things you are asking and so, you should listen to them carefully and follow their lead.

If you believe that I have been of assistance then, your written feedback (as last time you graciously provided) would be of value to me so I know how well I was on target to answer your questions.

If you do not have any further questions at this time would you also not forget to CLOSE THE QUERY.

Wishing you, your brother, and your family the very best.

This case required 60 minutes of physician time in reviewing, researching, and final documentation of written draft for envoy.
Above answer was peer-reviewed by
 
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