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Neurology (Expert Forum)
Cervical Stenosis, Spondylosis, Annular Tear and Scoliosis in Thoracic Spine
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Cervical Stenosis, Spondylosis, Annular Tear and Scoliosis in Thoracic Spine
by INGRASS, Sep 01, 2006 12:00AM
I am a 45 year old female diagnosed last year with cervical stenosis and spondylosis. MRI from last fall shows very prominent disks at C5-6 and C6-7 and associated changes cause "marked" narrowing of the spinal canal. Cord is compressed (doctor used the term "deformed") Is there a difference? Cogenitally small spinal canal.
Also, there is a small disk with an annular tear at T8 or 9. I moved slightly during MRI so only partial visualization of thoracic spine was obtained. No neurological deficit was found, EMG was fine. Close monitoring was strongly recommended.
I met with a neurosurgeon who told me that the small problem in thoracic spine would not get any worse. How did he know this?
The reason I'm asking is that a recent chest x-ray shows mild left convex thoracic scoliosis and I have had significant pain in mid to lower back for approximately 3 months. No pain there before.
I am scheduled for repeat MRI in two months, but back pain is significant. Still no true nuerological deficit that I know of.
Could the scoliosis be a new problem or was it probably there but not mentioned last year?
Also, no diameter was given for the stenosis. Shouldn't this have been evident on the MRI? MRI was of entire spine.
My new films will be compared this fall with the one from last year. Could you please list some questions I might ask regarding what other problems there could be with the spine? I really want to get a good understanding of all the problems there might be, not just the stenosis and ddd.
Thanks.
Also, there is a small disk with an annular tear at T8 or 9. I moved slightly during MRI so only partial visualization of thoracic spine was obtained. No neurological deficit was found, EMG was fine. Close monitoring was strongly recommended.
I met with a neurosurgeon who told me that the small problem in thoracic spine would not get any worse. How did he know this?
The reason I'm asking is that a recent chest x-ray shows mild left convex thoracic scoliosis and I have had significant pain in mid to lower back for approximately 3 months. No pain there before.
I am scheduled for repeat MRI in two months, but back pain is significant. Still no true nuerological deficit that I know of.
Could the scoliosis be a new problem or was it probably there but not mentioned last year?
Also, no diameter was given for the stenosis. Shouldn't this have been evident on the MRI? MRI was of entire spine.
My new films will be compared this fall with the one from last year. Could you please list some questions I might ask regarding what other problems there could be with the spine? I really want to get a good understanding of all the problems there might be, not just the stenosis and ddd.
Thanks.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 03, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
Given the compression in your cervical spine, you should be on the look out for neurologic signs of spinal cord compression:
-weakness in the arms and/or legs.
-Tingling, numbness or pain in the arms and/or legs
-Loss of bowel and/or bladder control
If you develop any of these symptoms you should seek attention immediately. Herniated discs can reduce by themselves, and you make be able to get by without surgery. I would recommend close monitoring with imaging. Chronic cord compression can lead to myelomalcia (permanent damage) in some cases.
Annular tears are a more difficult problem. In this condition the nucleus pulposus (liquid/gel material inside the disc) leaks out and irritates the nerves in the annulus (ligament that holds the disc together). This causes pain and may inhibit healing. Annular tears are best diagnosed by CT discography, but can often be seen on MRI (less invasive). Based on your description I would suspect that your pain is due to the annular tear, and may need surgery. Since I am not able to see your MRI or the Xray, I cannot tell you if the scoliosis was present on the MRI, but sometimes it can be commented on in the body of the report, but excluded from the 1-2 sentence impression. If you indeed have scoliosis, this can put additional wedge like pressure on your discs.
I would discuss with your surgeon if he thinks your pain is caused by the annular tear, and what interventions would be most appropriate for you. I would also ask if additional diagnositic options would be appropriate such as CT discography. I would also ask if your cervical cord compression is going to lead to permanent damage if not repaired, or if it has improved from the previous scan.
I hope this has been helpful.
Given the compression in your cervical spine, you should be on the look out for neurologic signs of spinal cord compression:
-weakness in the arms and/or legs.
-Tingling, numbness or pain in the arms and/or legs
-Loss of bowel and/or bladder control
If you develop any of these symptoms you should seek attention immediately. Herniated discs can reduce by themselves, and you make be able to get by without surgery. I would recommend close monitoring with imaging. Chronic cord compression can lead to myelomalcia (permanent damage) in some cases.
Annular tears are a more difficult problem. In this condition the nucleus pulposus (liquid/gel material inside the disc) leaks out and irritates the nerves in the annulus (ligament that holds the disc together). This causes pain and may inhibit healing. Annular tears are best diagnosed by CT discography, but can often be seen on MRI (less invasive). Based on your description I would suspect that your pain is due to the annular tear, and may need surgery. Since I am not able to see your MRI or the Xray, I cannot tell you if the scoliosis was present on the MRI, but sometimes it can be commented on in the body of the report, but excluded from the 1-2 sentence impression. If you indeed have scoliosis, this can put additional wedge like pressure on your discs.
I would discuss with your surgeon if he thinks your pain is caused by the annular tear, and what interventions would be most appropriate for you. I would also ask if additional diagnositic options would be appropriate such as CT discography. I would also ask if your cervical cord compression is going to lead to permanent damage if not repaired, or if it has improved from the previous scan.
I hope this has been helpful.
If no kyphosis present then ideopathic type (the most common type) would not or rarely cause cord compression
I always consider the main indications for a spine MRI ,for a follow up, are;pain, abnormal neurological exam, or thoracic curvature to the right.
regarding the spinal stenosis: I don't think there is any thing more to be done
Bob
Do you have some kind of medical training?
When I was diagnosed with this last year I knew virtually nothing about the spine and spinal cord. I am trying to learn as much as I can.
Thanks especially for the information that my condition could possibly get better. I helps to decrease the anxiety somewhat.
I will definately follow up with my gp regarding the back pain and scoliosis. If needed, he will call the neurologist and get an earlier appointment.
At some point, I will probably want a second opinion from another neurosurgeon. I will consider CCF if my insurance will allow it (and I think they will).
Have a great day!