Answers needed - urgent

[Sandra L]

Sorry for starting a new thread, but hoped I would get more answers here.

I didn't spend much time looking at my tests prior to ADR. I will be seeing Dr. McLain, Cleveland Clinic, tomorrow, Thurs, Jan 15 so I may be a little late in asking for help

I got out my MRI, Dec 2007, which Dr. McLain, Drs. Bertagnoli & Fenk-Mayer looked at before surgery. Dr. Mc said I need to do something, but avoid fusion, didn't offer any solutions, maybe call Dr. Delamarter. Both Dr. D and Drs B & FM said cervical ADR. Chose Germany, cheaper, more experienced doctor.

My MRI report, which I did not ask any doctor about, just let them tell me what I needed , follows: Is there anything here that I should be asking Dr. McLain about that might be causing my continued pain? I'm looking up many words I don't understand , but thought someone might be able to explain in simplier terms.

"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, disc was ruptured? no pain whatsoever, could the procedure have caused the disc to rupture? This finding turned my 3 into a 4.) There is some mild left-sided degenerative foraminal stenosis.

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 is 10 mm alot? There is asymmetric osteophytic foraminal narrowing more on the left.

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."

Thank you, Sandy Wade

[2cool4U]

I can address the spinal canal measurement questions. AP is the abbreviation for anterior-posterior. It is the measurement of the spinal canal from the back of the vertebral body to the bony structures that form the "ring" around the back of the spinal canal. Textbook descriptions indicate that 17mm is average, between 10-13mm are narrowed and less than 10mm is considered significant stenosis. A more reliable but less quoted measurement is a ratio of measurements of the thecal sac (spinal cord and its surrounding fluid) diameter to a measurement of the vertebra, something called the Torg ratio. A quick check of my references indicate that greater than 0.8 is good, but I can't give a better explanation at this time.

So it looks like 10mm for you is bordering on significant stenosis. I can also help with the term "congenital stenosis" used here. Not everyone is born with identical bodies. There is always a range of normal. This can be one reason why some people may have a large disc rupture or osteophyte (bone spur) but not have many symptoms while others may have problems. In your case, the radiologist is indicating that you were likely born with a relatively small spinal canal. When you get osteophytes, it probably doesn't take much to narrow things to clinically significant levels.

Please take this info as in general terms. As always, those looking at your MRI images will be able to give you specific answers.

Good luck.

[2cool4U]

I started to edit my above reply after I had time to look up info on the Torg ratio. I was going to delete that portion, actually, as I found conflicting articles on its utility. I also discovered gender variability.

However, I decided to leave the term in there and post this disclaimer. The readers of these forums are typically well-versed in the spinal literature, and I find everyone on here willing and very able to further review concepts presented here and decide for themselves.

Hence this disclaimer: The Torg ratio has been found to be an indicator of significant cervical stenosis by some that have studied it and not by others. You may want to do an internet search before getting out your favorite measuring device and applying it to your Xrays or MRIs.

[berry]

Sandy

As someone who has had a return of back and leg pain several years after lumbar disc replacement which is thought to be due to facet arthrosis at the operated levels you could ask if the facet degeneration reported or the foraminal stenosis could be a contributing factor. Perhaps it may also be caused by the osteophytosis though.

Determining the generators of continued pain is difficult and I hope you get some answers tomorrow.

Don't expect that helps you but wanted to reply to your post to let you I we care.

Best wishes

Lynda

[phylly]

Sandy,
My only input is that I was also born with a small canal and the bulges and bone spurs created severe stenosis at two levels in my neck. I had those fused but the doctor left the other levels that were not as effaced alone as he did not want me be to be too stiff. I hope that you can get several opinions, it helps.
Phylly

[Sandra L]

tconner and all,

Thank you for the info. I'd like to think I can ask intelligent questions, but I was so wrong on the "sac 10mm AP". I thought they were talking about the size of the disc buldge .

I've got more time now to make out a list of questions for the doctor.

Not that I can do anything about it, but the disc's might not have been my problem? Although on the MRI it shows the 3 lower disc's were making an indentation on my spinal cord.

1) Should the narrow canal have been fixed before my ADR's?

2) If canal is a problem, can it be fixed after ADR?

3) I had a discogram on the upper disc, C2-3, but no pain, the fluid just ran out - so 4 discectomy's, 4 ADR's. If the upper disc was causing no pain, should it have been replaced?

Boy, I sure didn't ask the right questions pre-op.

Sandy

[Toebin]

Sandra,

About the only thing I can add to what has already been said is...

With a small canal to begin with any osteophyte complex or bulging disk will have far more impact on you than someone with a larger canal diameter. It's just basic science.... if you have a small area, it takes less stuff to fill up that area.

This is all based on your pre surgical MRI and I would think with the ADR placement you had done, most of the endplate osteophytes have been removed already. It would be interesting to see if you still have any post op and if they are inpinging on the spinal column or nerve roots now.

Stenosis is not corrected with ADR placement usually although I'm sure the surgeons cleaned up most of the bone spurs (osteophytes) that they could reach, if your central canal is small and you still have any stenotic areas , it could have a significant impact.

I would think at this point getting a true picture of what exactly is going on in your neck would be vitally important to any further surgical interventions. I know MRI's can be done post ADR, but I've hear it also causes fuzzy pictures of the areas that have the devices. I'm not certain if a CT scan would give them the information they would need to see if your spinal column is being pinched anywhere. This might be something to ask about however.

[Sandra L]

Toebin,

Your suggestions are a big help. Now that I understand the 2007 MRI I am developing a good list of questions and don't have to waste time on questions that I'm sure would cause the surgeon to and shake his head!

The scary thought that keeps popping up now is "what if the stenosis is causing the pain?" Another surgery? Could Dr. B have enlarged the canal while he was implanting the adr? Guess, I'll quit worrying and cross that bridge if necessary.

I'm hoping that the pain is all musculature. Then the best treatment is trigger point injections? I tried chiropractic and massage after surgery, but it just gave me too much pain for too long, so I quit. Went back to muscle relaxers and pain meds.

Well thanks so much, these sites are so helpful. It's too bad the doctors can't do this, so being prepared with the right questions helps. Sandy