Originally Posted by SandyW
Now, I don't understand my MRI from 12/2007. Didn't ask enough questions, knew I didn't want fusion. Am going to see spine doctor at Cleveland Clinic finally for a much needed follow-up (Dr. B had to refer me) and want to be able to ask some intelligent questions. Looked up terms, got some thoughts from other site, but need the explanation from the "experts."
"There is some mild straightening of the normal cervical lordosis without focal subluxation. Overall spinal canal diameter is somewhat small, suggesting an element of congenital stenosis.
There is generalized multilevel disc desiccation and degeneration, mainly involving C3-4 through C6-7.
At the C2-3 level, no focal disc protrusion.(Had a discogram in Germany prior to surgery, no pain whatsoever, Dr. FM said dye went in and out, could the procedure have caused the disc to rupture? Decision made to do 4 adr's instead of 3.) There is some mild left-sided degenerative foraminal stenosis.
Sandy, no expert here. I'll help answer your questions: in my opinion, I don't believe the procedure caused the disc to rupture. As you are aware, a needle is slowly inserted into the disc in which contrast is injected during a discogram. This causes an increase in pressure in the disc (chemical irritation, etc. etc.) resulting in pain.
Your discs are similar to "pin cushions." This is a really poor example, but it's an easy one..the annulus fibrosis is the outermost portion of each disc, in which fibers are wrapped around each other many times (picture a wicker basket) and the center of the disc is the nucleus pulposus--it's similar to a jelly-like substance that is held in place by the annulus fibrosis that encircles it. During the discogram, when the needle is inserted into the disc it "pokes" through/around the annulus fibrosis fibers. IMHO, this would not result in an annular tear, especially since the technique of discography has been greatly improved over the years. (This is not to say it has never happened in the past.) Also, the size of the needle (or gauge) that is used is very small.
With the dye "going in and out" like you describe, it sounds like the tear in this disc was pretty big. This means your disc was unable to "hold" any pressure from the injection. A smaller tear would be able to hold more pressure/dye and in theory less dye would leak from the disc at a slower rate. However, this varies depending on the grade (size and location) of the tear.
I notice it states "At level C2-C3, no focal disc protrusion." This is why discography is done--discography is not used to look for herniations per se, but it is used to look at what is termed "internal disc disruption." This means it is looking for tears that are not easily visualized on xrays or an MRI.
If you took 10 people off the street at random and gave each person an MRI, most of these patients would have some degree of protrusion (herniations) / cysts that are asymptomatic. Thus, not all protrusions are problematic -- especially as we age.
I hope this makes sense...
At the C3-4 level, there are endplate osteophytes and some degenerative changes in the facets. The sac measures 9 or 10 mm in AP dimensions. (What is AP and what does 8, 9, 10 mm dimensions mean?) There is asymmetric osteophytic foraminal narrowing more on the left.
AP is anterior posterior: this describes the way “the picture” passes through your body – here it is going “in” your neck (front) and then “out” (back) of your neck. Anyway from the literature I have read, stenosis is defined as AP dimensions of less than 10 millimeters.
At the C4-5 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac which measure 9 or 10 mm in AP dimensions. There is some osteophytic foraminal narrowing, greater on the left.
At the C5-6 level, there are endplate osteophytes. There is indentation on the anterior aspect of the sac, which measure about 8mm in AP dimensions. There is asymmetric osteophytic foraminal narrowing, greater on the left.
At the C6-7 level, there are endplate osteophytes indenting the anterior aspect of the sac, which measures about 9mm in AP dimensions. Exit foramina are only slightly distorted.
At the C7-T1 level, no major abnormality." (was there anything in MRI that said adr?, I didn't ask, just took advice, fusion or replacement, although film showed disc's making indentations on spinal cord, anything that might suggest why I have more pain now than pre-op? Not sorry I had adr's, couldn't stand the thought of fusion, but am wondering why the pain)
Sandy, there was no mention of ADR on the MRI. The MRI usually only reports on how your cervical spine and surrounding structures “look.” Based on this MRI, then your surgeon(s) decide what the next step in treatment is based on these films, other tests, your medical history, etc... It does sound like there was some compression of your spinal cord before surgery (so it sounds like you had issues that needed to be addressed one way or another—I’m going out on a limb here, as I don’t have your films in front of me).
There could be a whole host of reasons for continued pain. It gets tricky, as you know…I’m still trying to work up why I have constant bilateral leg pain after 4.5 years of pain-free life post-ADR.
I wish you the best and I hoped this helps…keep us posted.
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