Brief Answer:
Herniations and arthritic disease

Detailed Answer:
Good evening. My name is Dr. Dariush Saghafi and I would like to answer your questions this evening on your MRI results.

You mentioned the fact that you feel as if you have "knives" in your back but exactly which part of the back are you referring to? When I read the MRI report the majority of what I see that is going on has to do with your symptoms in the left hand and arm which have been numb for a couple of days and that comes from the pathology in your neck not the back.

At any rate, I can tell you that what is going on in the cervical spine which is designated by the letter C is that of a couple of small herniated discs which are causing some narrowing of the spinal canal and also causing irritation of what we referred to as the C6 nerve root.

That in and of itself may be causing you to have shooting pain as well as numbness and tingling sensations going from either your shoulder or your forearm into your left thumb primarily. Do you have such symptoms? In addition, there may be some weakness in the thumb or part of the hand on the thumb side as well as the wrist and forearm in terms of turning it over and back. Do you have any such weakness?

The rest of the MRI report talks primarily about discs in the ass expiring which are designated as you can imagine with the T. The numbers simply designate which disks and it which level we are talking about. For instance in the cervical spine there are actually seven vertebral bodies although there are actually eight cervical nerve roots that we talk about.

In the thoracic spine there are 12 vertebral bodies as well as disks. Whenever you see a designation such as T3-4 or C7-T1 what they are talking about is an actual disc between two particular vertebral bodies so in the example of T3-4 we are talking about the disc that sits between T3 vertebral body and T4 vertebral body.

so once again all of the technical terminology that they are talking about in the thoracic spine simply refers to degenerative changes caused by arthritis which are usually due to natural or normal aging processes. There does not seem to be any significant pathology in the thoracic spine except at T9-10 there seems to be a small protrusion on the right side without any pinching her squeezing of the nerve root it comes out at that point.

Nevertheless, if you are actually having pain in the spinal column in the lower back region or thereabouts it could be due to this particular disc which is protruding without pinching any nerves. Similarly there is another small protrusion going on at T8-nine with a little disc degeneration.

So to answer your question of "how bad is my back?" The answer is it's really not THAT bad in when looking at a small portion of your back namely T1-T10. The most we would say based on the MRI report is that you have areas of degenerative arthritis which is likely normal for age and with the exception of a couple of levels were you have very small disc bulges everything else in the thoracic spine looks reasonable.

The major action seems to be in your cervical spine or your neck where you definitely have two small areas of herniations one of which is definitely causing a pinched nerve root at the C6 level on the left which definitely correlates to some clinical symptoms of numbness tingling and even pain and weakness in the left hand/Wrist/forearm.

There are a couple of things that I would recommend doing at this point. One is to get you into some form of physical therapy at least with the neck if not the whole back. That would include aquatherapy which I think would help quite a bit. Over 50% of compression types of pathologies or "pinched nerves" which you have at least one maybe two in the cervical spine Will resolve by themselves without surgery and just by doing normal activities of physical therapy or specific exercises and stretches in the particular spinal area of interest. In other words, surgery is not necessarily needed to correct these problems in at least half the cases.

I would definitely not allow the chiropractor to do any type of neck adjustments or neck manipulations because these can be dangerous. If you wants to recommend doing manipulations of the rest of the back that is not such a problem. but you should always remember what I say about allowing anyone to mess around with your cervical spine or your neck under any circumstance and that should be off-limits no matter what.

Remember, I am talking about neck adjustments or had thrusts, or other maneuvers which cause rough engagement of the cervical spine or extreme stretching as would happen in a whiplash injury. typically these sorts of things are recommended by chiropractors despite solid evidence in the literature as well as warnings from the XXXXXXX Academy of neurology and other medical associations and groups that recognize the danger of those procedures. Still, many many chiropractors and other types of interventionalists and even therapists have jumped on this bandwagon of medical treatments for chronic pain syndromes and unsuspecting people are getting hurt and injured all the time with these maneuvers. I've actually witnessed one death directly as a result of these maneuvers when I was in training. Two other cases that I saw while in training at University hospitals of XXXXXXX resulted in severe neurological deficits in young women with families and children which turned out to be permanent and place them either in wheelchairs or on respirators.

so, if you think I'm telling you all this stuff just to scare you-you are correct.

On the other test I would definitely consider doing in your situation because of the cervical spine issues of herniated disc would be what's called an EMG or electromyelogram. it's a somewhat uncomfortable test to do because needles are involved but it gives excellent information in terms of the status of the nerves that are being pinched and tells you whether they are honestly in need of surgical interventions versus conservative treatment plans.

I will stop at this point for now and suggest that you find either a good neurologist in your area or a very good physiatrist who knows how to do solid EMG work. I would look for some guidance in terms of physical and kinesiotherapy without the use of chiropractic maneuvers and definitely with aquatherapy.

If I have satisfactorily addressed your questions tonight would you be so kind as to return a small written feedback statement with a star rating on how well I was able to hit the target.

And if there are no further questions to ask in your case could you also remember to close the query from your side so that the network may archive the transaction and know that we satisfactorily took care of your questions.

Have a great rest of the week and weekend. I hope your condition improves quickly.

This case required 60 minutes of Physician specific time for review, research, and final draft documentation for envoy.

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Brief Answer:
Hello once again

Detailed Answer:
Thanks for the additional information.

In my opinion, I believe there is no question that improperly sized and heavier breast implants may have added non-trivial contributions to your back problems. Eating Advil like candy is never a good thing either since other complications including bone thinning can occur.

Your symptoms on the left are clearly related, in my opinion, to the herniated disks but as I said previously (and I stand by the notion that 50% of herniated disks in the neck and back can and do heal on their own. However, 50% do not. I'm also not a huge fan of cortisone shots into the back so that answers that question! ;)

Also, don't forget that a good EMG done for this problem would be much more valuable than practically any further imaging or lab studies could be.

It would be unfair for me to recommend you to a neurologist since I have an OBVIOUS INTERNAL bias to those folks because I'm one.....but I honestly believe you're in better hands with a good neurologist who understands this problem and what the options are. And yes, by all means take your MRI films with you!

If you feel this information was useful to you then, could you send me a little written feedback and a STAR RATING of the conversation as well as CLOSING THE QUERY on your end if you are not in need of asking further questions. Many Thanks.

This query required 16 minute of physician specific time to review, research, and document in final draft form for envoy.

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