MRI Results
 

Hello,
I just joined. Hope everyone is doing very well. I have a lot of symptoms that have been going on for about two years and are getting worse. Pins and needles down arm and in hands, constant tightness and soreness of neck and upper back and shoulders, going down triceps. Etc etc. it's gotten much worse just recently. The pain is often excruciating.

Got my MRI results report from last April (not sure why I waited this long; I just listened to the gist of it from my PCP). I don't know how to interpret them really and if someone is familiar with these results I'd appreciate any thoughts. I just want to be sure I'm not going crazy and that the pain is not partially psychological. I know it's there and that it's agonizing. But I don't see the words "severe" or "nerve" in the MRI, so I'd appreciate educated thoughts.

I'm looking into ADR with Dr Clavel who has amazing reviews. I can't take any more of this pain as it is debilitating.

History: neck/back pain and left shoulder/scapular pain.

Results:
There is a straightening and mild reversal of the normal cervical lordosis. Mild disc space narrowing is seen at C5-C6 and C6-C7 with associated endplate degenerative changes and marginal osteophytes. No fracture or suspicious marrow-replacing lesión is seen.

Slightly low-lying cerebellar tonsils are noted. The visualized posterior fossa and spinal cord are otherwise normal in signal.

By level:
C2-C3: Unremarkable
C3-C4: Unremarkable
C4-C5: Unremarkable
C5-C6: There is a mild left-eccentric posterior disc-osteophyte complex consisting of a minimal disc bulge and small greater than right uncovertebral osteophytes. This effaced the ventral thecal sac without central canal stenosis or foraminal narrowing.
C6-C7: There is a moderate left-eccentric posterior disc-osteophyte complex, including a moderate disc bulge and moderate left uncovertebral osteophyte. This effaces the ventral thecal sac without central canal stenosis. There is moderate left foraminal narrowing.
C7-T1: Unremarkable.

Impression:
Degenerative changes of the cervical spine at C5-C6 and C6-C7, as detailed above. At C6-C7, a left-eccentric posterior disc-osteophyte complex results in moderate left foraminal narrowing at that level.

What do you think? I'm kind of freaking out here.

Standard rule of thumb: your imaging results and your pain don't always match up. You might feel severe pain but look okay on an MRI image set or the reverse.

That said, it's clear that your images show that you have a real problem at C5-6 and maybe at C6-7. Does your pain match up with those levels? There's charts that show enervation pathways for each disc level. If it does, then your symptoms and your imaging match up. If not, it's worth your time to figure out what doesn't match. You can have a secondary effect: a nerve that is pinched causes a muscle to spasm which compresses a nerve that your imaging doesn't suggest should be irritated. If something like that is happening, the secondary effect should be temporarily lessened if you do a trigger point release or other means to reduce the spasming of the first muscle.

If you're asking if it's time to get an ADR, that's a different kind of question. I'd certainly say that your pain level indicates that it's time to start talking with surgeons and pick one you like. Whether you immediately pull the trigger on the surgery once you find one is a real personal decision and affected by how you perceive your pain level, worsening condition, and general quality of lfe.

annapurna,
Thank you so much for your response. I can say with 100% certainty that if Dr Clavel said he would do the 2-level ADR tomorrow, I'd be on the first flight to Spain. I hate to spend the money (over $30,000USD!) but this pain is ruining my life (not to sound melodramatic).

Does your left arm cause you more problems than the right? Notwithstanding what AP mentioned above, I see the C-6-7 left foraminal narrowing jumping out at me. But also like mentioned above, images and reality sometimes don't match. Have you tried PT and strengthening exercises? You might be able to open the space up enough for some relief.

My left arm is definitely bothering me more than the right. I'd do PT further than what I've been doing, but it doesn't help. I just want this fixed. It's been causing me many personal issues over the past 1.5 years. My wife is getting bored, which is not a good thing. I've sent my MRI and report to Dr Clavel, and I hope he can fix this. Do your think he can Fix this? Didn't you go to him, PhillyJoe?

I had actually used an inversion table, cervical traction collar, foam rollers, TENS unit and massage, and the pain has amplified significantly. It's my neck and upper back that are in just excruciating pain.

Failed trials of oral steroids? Gabapentin or other similar neuropathic pain meds?

Taking plaquenil but it is giving me excruciating migraines, so I'm stopping it.

Gabapentim i refuse to take because of the permanent damage I've heard it can do.

I've taken massive amounts of pain medication and I'm tired of needing it. Plus it doesn't stop the pain anyway.

Yes, he can fix "it". Just need to be sure you have completely identified what 'it' is. I am not married, but I'd venture a guess that wife getting bored isn't one of the top 5 reasons to risk your life in surgery!!

Isn't Plaquenil an anti-malaria drug??
So you never tried steroids?
Are you in the US? Have you consulted w/ any surgeons yet?
And the last MRI is 11 months old? You need a new one.

Got my results from the MRI I had a couple days ago:

There is straightening and mild reversal of the normal cervical lordosis. The vertebral body heights are maintained. The marrow signal is unremarkable. Both vertebral arteries demonstrate normal flow-related signal loss.

The cervicomedullary junction is normal. No tonsillar ectopiabus present. The cervical cord is normal in caliber and signal intensity. Individual disc levels are as follows:

C5-C6: Disc dessication with mild disc space narrowing and ventral disc osteophyte formation. There is minimal annular bulging which indents the ventral thecal sac without significant central stenosis. The neural foramina are widely patent and the facets are unremarkable.

C6-C7: Disc dessication with disc space narrowing. Posterior Disc osteophytic ridging is assymeyrically more notable on the left, indenting the ventral thecal sac without significant central stenosis. There is mild right and moderate left foraminal narrowing due to posterolateral disc osteophytic ridging and uncovertebral spurring with brief impingement of the exiting left C7 nerve root.

Conclusion:
1. Straightening and mild reversal of the normal cervical lordosis which is nonspecific and may be positional or due to muscular spasm.
2. Stable cervical spondylosis with intrinsic discogenic degenerative changes most notable at C5-C6 and C6-C7. Foraminal narrowing is most notable at C6-C7 on the left with brief impingement of the exiting left C7 nerve root. No significant change in comparison to the 4/17/16 exam.

Pretty sweet, eh?

Dave,

Hey can you explain what this term is? It's new to me: ectopiabus.

Also, pls see the "add a signature" link:

https://www.adrsupport.org/forums/sh...ad.php?t=11053

Thank you.

That should be ectopia. Sorry about that. Auto-correct.

Dear Dave. Sorry for your pain. I have DDD and spine pain since my early 20,s (more then 20 years ago). At that time only fusion was available. My rule of thumb was wait 1-2 years before surgery trying all therapy possible (muscle strengthening etc). In my case they did not work. Pain pills didn't work either. Last 2 years started with cervical pain and decided for a surgery with Dr Clavel (I like him, but choosing Dr is a personal preference). Still 8 days after surgery but I am feeling good. My advise: with current ADR technology and amount of surgeries increasing a lot everywhere (after Adr approval of many devices) you shoul find a good Dr with a lot of experience with adr and talk to him. Most of the time ADR work well on the cervical area (lumbar they also work but for sure can be more challenging). So search for a Dr (I usually talk to at least 2 before a surgery) write down your questions and good luck. I think in this website you have a lot of information regarding patients outcomes. So use it.

Thanks, ANDREH! Dr Clavel is the surgeon I'd like to go to. I'm worried, though, because I'm waiting on a response after sending all my recent info in. I really hope he takes me as a patient.

Did he tell you you could lift heavy weights after having the cervical ADR?

Dave,the best way to talk to him is to call Yolanda, at least for me it worked well. Regarding weights I will give my short answer: avoid it as much as you can for the first couple of months. I will avoid heavy weights for life, but that just my opinion!! But that is my approach after more then 20 years with DDD. And I love exercising.

I just heard back from Dr Clavel. He recommends 2-level cervical ADR with the M6. It will cost about $33,000. All out of pocket.

Serious question, what would you do? Would you go with Dr Clavel? I juuuuust barely have the money. But I am desperate to be able to lift weights again and live pain free. Is Clavel better than those in the US, like at the Texas Back Institute, for example?

Dave, my 2 cents...any surgery is a risk, and even if successful, you may have a 'new normal'. If you want to stop further breakdown of your cervical spine and get out of pain, then surgery may be warranted. If you just want to be able to lift again, your expectations may be misplaced. TBI has great docs, Clavel is a great doc and stellar human being. Both good surgeons, but you also need to choose your preferred device for your situation. Doc pick comes first, device second, money last. Today is 9 months to the day of surgery, June 29th, for me. Everyone turned me down for ADR including TBI, Clavel, well....may God bless him and his team..and I say it mostly everyday

Thanks, phillyjoe. So you had surgery with Dr Clavel, I see. Are you not able to lift weights? I take it the surgery was a success?

Cervical ADR
 

Dave234 A two level ADR for 33K , by a world class Dr. seems like a very reasonable price. Does that include "everything" minus of course airfare / hotel etc.? In the US the price would probably be 2 to 3 times that. I have heard of people purchasing a one year insurance policy of some sort ,from Euro / spine Drs. is that available from Clavel ? Good luck !, I think from what I have read in you are in good hands with Clavel.

I bought that insurance from Clavel, but can’t really tell you what it covered. Someone who had a lumbar adr installed by Clavel, and who later decided to have it removed, was considering going back to Clavel for the revision to fusion. The insurance would not have covered 100%. I think the insurance I paid was expensive at 10% or so of the total surgery cost.

Dave, I get it that you want to lift. I never had an interest in weight lifting and even if I did, I would not tempt the loss of my investment and return to pain. No reason to do it. My thing was running for 40 years. Same answer. Clavel will say you can do whatever you want once the surgery is determined to be successful. He has a very positive outlook on life. But why risk it ? I am happy for my new normal and don’t ever want to go back to where I was. I also came out of ADR with a torn rotator cuff due to a head accident two weeks following surgery. So stuff happens.

Search for posts by jeffandage on this board and you will be thankful for a good outcome.

phillyjoe, are posts from jeffandage going to be extremely horrifying in the sense that he got messed up from adr? I hope not. I hope he is doing well.

When I talk about weightlifting, I mean like 50 lb dumbbells. Nothing crazy. It makes me crazy to think I couldn't do that again.

phillyjoe, are posts from jeffandage going to be extremely horrifying in the sense that he got messed up from adr? I hope not. I hope he is doing well.

When I talk about weightlifting, I mean like 50 lb dumbbells. Nothing crazy. It makes me crazy to think I couldn't do that again.

Dave,

Pls see:

https://www.adrsupport.org/forums/sh...ad.php?t=11053

Let me know if you need help. :look:

Hi Dave,

I don't really see why it would be impossible to do 50 lb dumbbells, but it is always a question about if you want to risk it or not. Is lifting those dumbbells your profession that brings you bread on the table, then yes, you can do it. But if it is a hobby that you do to have fun and keep healthy, then why not just use smaller dumbbells and stay safe? I am not expert on the cervical spine (I have studied more on the lumbar), but I can make an educated guess that the larger the weight of the dumbbell, the larger the torque that is transferred to your spine, even if you are not directly using the neck for the lifting.

Dave,
50 lb dumbbells are within the capability of what the ADRs will give you but almost all of that will depend on factors outside of the ADR itself: how much soft tissue damage do you have now, placement of the ADR, healing post-surgery, and, especially, how careful and extensively you regain your strength and flexibility post-surgery.

It's nearly useless to warn you about going too hard post-surgery; everyone does it at some point in their recovery. Instead, listen to your body carefully and do your best to limit how much and often you overdo it. That said, you're going have to do a lot of post-surgery strengthening if you want to lift 50 lbs safely.

I think it is better to use the machine rather than free weight training. This will sure keep you safe from putting weight down your spine. I am planning of doing it after my ADR operation but i will make sure to do body weight workout first. That is to see, one self will have any problem on the back. I am not sure what is your lower back look like, if they are really good then you will not have to worry more like some of us who has a bad back. Well, you will not want to join us in future of your bad problem so take it easy and enjoy life. Keeping fit and healthy, can be in lot of differences way. Such as eat clean and do high intensity workout with less weight will still give you the body physic one has before. So it is still up to individual that want to risk an operation again. I will not want to step there again if i am fully recover to 85% of my old self. The fact that we will not be the same as 10 or 20 year ago, as WE ARE MORTAL !!!

So many new members are not adding signatures. Please do!

https://www.adrsupport.org/forums/sh...ad.php?t=11053

I just added my signature.

I had 2 ADR CERVICAL done by Dr. Clavel, I'm female so probably don't lift as much as you but I can now deadlift 65lbs over my head. I'm doing Crossfit 3-5 times a week. The only thing I don't do a lot of is running, it bothers me more than any other activity. I do a mile and that's about it. If I do a 5k, I run and walk.
I started out barely lifting 5 lbs my nerves had been so compressed.... even now 4+ years after surgery there is not a day that goes by that I don't stop and say a little Thank you for Dr. Clavel.

Wow! That's great news, 2Confused! I'm very happy to hear you're doing great!

Hi Harrison,

I did have my signatures done last time and i know what is the problem as it has limited words count on it. So i did wrote again and now i have the signatures. I agree as we are sharing information and sure help to understand each other history and condition.

Cheers
Don

My case gets more and more confusing. Dr Blumenthal, after looking at my images, doesn't recommend adr or fusion. This is baffling. I truly do not understand.

Does he give reasoning? What have your other opinions been?

He gave zero reason. Apparently he looked at it briefly. It's really weird.

Dr Clavel (Barcelona Spine Institute neurosurgeon) recommends 2-level M6C. Says the degeneration is clear.

Dr Fred Mo (US orthopedic surgeon) says because I have spinal arthritis,adr could make my pain worse, and that he recommends 1-level fusion.

This is bizarre.

I'm getting very frustrated because I know for damn sure I'm not creating this pain psychologically. I hear and feel my bones crack and crackle with every move I make.

I need to get on with my life!!!!!!!!!!!!!!!!!!

Sorry. Didn't mean to yell. I'm just so frustrated with this and it seems like even the most celebrated minds in this specific field can't even come to a consensus. There has to be one right answer. And I need to know it VERY SOON.

Dave, suggest you calm down and continue to proceed logically. It is sadly very common to have as many opinions as you have surgeons. The fact that you hear noises, of course, could have very little to do on whether a disc is compressing a nerve. In fact, it suggests facet issues. If you have facet issues, you will still have them after ADR, and maybe ADR , depending on the device, may cause those facet issues to get worse.

I am not a doc, but having gone to Clavel, what I am seeing in your posts is a series of docs who say you don't need intervention now, i.e. wait for it to get worse and really show on mris, vs Clavel, who sees something that maybe not terrible now, but will get worse. So Clavel says take care of it now-before it causes damage to discs above and below. So if that analysis is true, you have to decide which approach you agree with, and decide whether you go now -as Clavel suggests- or you go later- when all docs agree things are bad enough that they really show. I waited until I started dropping things with my right hand to decide, yes, pain and function had gotten bad enough. I should not have waited