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Questions about my spinal MRI's..

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Unread 11-18-2006, 06:45 PM   #1
GinaMarie
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Question Questions about my spinal MRI's..

First of all...

What is the difference btwn Disc bulging and disc herniation? Now I need it in easy laymans terms as my brain doesnt comprehend complicated stuff. lol

Now here are what my MRI's said.. I had MRI's done on my cervical, thoracic and lumbar. These were done in a "Standing/sitting" MRI

Cervical: Findings
The C2-3 disc demonstrates mild central disc bulging.

The C3-4 - normal

The C4-5 & C5-6 discs demonstrates mild central disc bulging

The discs from C6 to T1 are normal

The thecal sac shows no other intradural or extradural abnormalities. There is no evidence of central canal stenosis.

The cervical spinal cord is normal in appearance. There is no suggestion of myelopathy.

Impression: MRI of the cervical spine demonstrates some DDD with no evidence of disc herniation or myelopathy.

Thoracic: Findings-
Minimal intervertebral disc bulging is demonstrated from C5-L1. There is no evidence of disc herniation.

The thecal sac shows no other intradural or extradural abnormalities. There is no evidence of central canal stenosis.

..... etc.....

IMPRESSION: MRI of thoracic spine demonstrates mild to moderate DDD with no evidence of disc herniation of myelopathy.

Lumbar: Findings-
There is mild dextroscoliosis of the lower lumbar spine.

The T10-11 disc are normal

The T11-12 disc demonstrates minimal broad based disc bulging.

The T12 to L4 are normal

The L4-L5 disc demonstrates mild decrease in height and signal intensity with minimal broad based disc bulging.

The L5-S1 disc demonstrates mild decrease in signal intensity with mild broad based disc bulging. Bilateral spondylolysis is demonstrated with grade 1 spondylolisthesis. Moderate bilateral foraminal stenotic changes are demonstrated.

The thecal sac shows no other intradural or extradural abnormalities. There is no evidence of central canal stenosis. The conus medullaris is normal. Bony structure shows no evidence of fracture or contusion. No marrow replacement process is seen. No paraspirous abnormalities are demonstrated.

IMPRESSSION:
Bilateral spondylolysis with grade 1 spondylolsthesis and moderate bilateral neural foraminal stenoses are demonstrated at L5-S1.


I know I've been told I have Spina Bifida Occulta in my lower back AND in my cervical. I know the cervical is rare. Its because of my rare disease (BCCNS - Gorlin Syndrome). Is any of this technical terms stand for the that?

When I saw my back surgeon last week he was telling me that my nerve root on my L4-L5 was compressed and that was causing my drop foot and that by doing surgery to release it could help my foot. He says I will eventually need surgery tho he would have to see if my disc was any good as he says it doesnt look too good on the MRI. I'm NOT rushing into surgery. I wear AFO braces on my legs/feet to help me walk and to keep my feet up (to prevent the drop foot) so Im not worried about the drop foot. lol Right now Im dealing with sharp pains shooting across my right rear "back hip" area. Especially when I make certain movements.. Is that the back like the same L5 area? or my hip? I've had my TENS unit on it cranked up HIGH to divert the pain.

ANYWAY.. thanks for any help interpretting these for me...
Gina Marie
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GinaMarie - Basal Cell Carcinoma Nevus Syndrome (BCCNS) also known as Gorlin Syndrome, Multiple other stuff, Mother to 4 miracle boys.
Nathan - Adhd,
Caleb - Adhd,
Adam - BCCNS, Adhd, Chiari Malformation,PDD-NOS
Noah- BCCNS, Adhd, Chiari Malformation, Bronchial Stenosis, Asthma
Thank you Jesus!! He walks with us thru all of this because he will never leave us nor forsake us!! He is my BESTEST friend!!!
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Unread 11-18-2006, 09:45 PM   #2
GJZH
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Gina Marie,

So sorry you are having pain...I will try to help with the definitions of disc bulge and herniation as best I can...


Desiccation - loss of disk water

Disk bulge - circumferential enlargement of the disk contour in a symmetric fashion

Protrusion - a bulging disk that is eccentric to one side but < 3 mm beyond vertebral margin

Herniation - disk protrusion that extends more than 3 mm beyond the vertebral margin

Extruded disk - extension of nucleus pulposus through the anulus into the epidural space

Free fragment - epidural fragment of disk no longer attached to the parent disk
Milette PC, Proper terminology for reporting lumbar intervertebral disk disorders. AJNR 18:1859-66, 1997.


Quote:
Definition: A 'disc bulge' is a word used to describe findings seen on a MRI study of the spinal discs. The spinal discs are soft cushions that rest between the bones of the spine, the vertebrae. When a disc is damaged, it may herniate, or push out, against the spinal cord and spinal nerves.
A 'disc bulge' is a word commonly used to describe a slight outpouching of the disc. The words 'disc bulge' imply that the disc appears symmetric with a small amount of outpouching, and no significant herniation.

Disc bulging is often an incidental finding on MRI. As people age, disc bulges are commonly seen on MRI. Disc bulges can be seen in patients with no symptoms of back problems, especially in patients over the age of 40. A physical examination can help distinguish a disc bulge that is causing problems from a disc bulge that is an incidental finding.
Image of a disc bulge:


Image of a herniated disc:



A disc protrusion generally refers to a broad-based or slightly asymmetric bulging of the disc with an intact annulus and reflects disc degeneration (see below). Sometimes you may even see the term focal disc protrusion, which usually means the same thing as a disc herniation.

In your lumbar spine they describe the scoliosis as being dextroscoliosis which simply stated means this:

Quote:
Scoliosis is never normal. It is considered scoliosis when the amount of curvature of the spine is > 10 degrees. It usually is due to congenital malformations or muscular disease. We categorize it by age of onset. The pattern is named for the locations (e.g. cervical, thoracic, or lumbar) and the side of the convexity (levo is where the convexity is to left and dextro is to the right). The time of most rapid curvature is just before and during puberty. There is usually little progression of scoliosis after puberty, unless the patient has muscle disease and the disease progresses. Curves < 20 degrees usually do not cause health problems but anything over 40 degrees usually requires surgery.

About Spina Bifata:
Quote:
Spina bifida occulta is common. Two studies undertaken in Great Britain in the mid 1980s suggest that 22% or 23% of people have spina bifida occulta. Even though there is a very slightly increased chance of a slipped disc, very few people with spina bifida occulta will ever have any problems because of it. If a person has no symptoms from spina bifida occulta as a child, then it is unlikely that they will have any as an adult.
Most people will not even be aware that they have spina bifida occulta unless it shows up on an X-ray which they have for some unrelated reason. It is usually just a small part of one vertebra low in the back which is missing. See the diagrams below that show cross sections of one vertebra.
In your lumbar spine they also talk about moderate bilateral neural foraminal stenoses... An explanation of neural formainal stenosis:
Neural foraminal narrowing is a common result of disc degeneration. Spinal nerves pass through an opening in the spinal column known as the foramen. The process of disc degeneration or bulging causes the foramen to become narrower. Once the foraminal opening reaches a point of compressing the nerves inside the spinal column, pain, numbness, tingling, and muscle weakness often occur.

Other possible causes of neural foraminal narrowing include rheumatoid arthritis, osteoarthritis, chronic meningitis, tumors, and neurofibromas. Any type of neural involvement should be identified and treated to limit the amount of permanent damage that can result. The most common method of confirming a diagnosis of neural foraminal narrowing involves some type of diagnostic imaging--MRI, CAT scan, etc.

Radiculopathy as well as sciatica is the radiation of pain to the lower extremity. It is the result of pressure on a nerve root, usually by a herniated lumbar disc. Besides a disc, other sources of compression may be arthritic spurs, spinal stenosis and foraminal stenosis.

Lumbar nerve roots, their distributions, and the discs which commonly affect them
L1 sciatica: T12/L1 disc; L1 root supplies sensation to the thigh and the anterior scrotal or anterior labial branches, as the ilioinguinal nerve. The lumbar disc which would typically affect this nerve is the T12/L1 disc centrally, or the L1/L2 disc laterally in the neural foramen.

L2 sciatica: L1/L2 disc; L2 root supplies sensation to the front and side of the thigh, as the lateral femoral cutaneous nerve. The lumbar disc which would typically affect this nerve is the L1/L2 disc centrally, or the L2/L3 disc laterally in the neural foramen.

L3 sciatica: L2/L3 disc; L3 root supplies sensation to the front and side of the thigh, as the lateral femoral cutaneous nerve. The lumbar disc which would typically affect this nerve is the L2/L3 disc centrally, or the L3/L4 disc laterally in the neural foramen.

L4 sciatica: L3/L4 disc: L4 root supplies sensation to the anterior lower thigh. The lumbar disc which would typically affect this nerve is the L3/L4 disc centrally, or the L4/L5 disc laterally in the neural foramen.

L5 sciatica: L4/L5 disc: L5 root supplies sensation to the top of the foot and the great toe. The lumbar disc which would typically affect this nerve is the L4/L5 disc centrally, or the L5/S1 disc laterally in the neural foramen.

S1 sciatica: L5/Sa disc: S1 root supplies sensation to the outside of the foot, and the small toe. The lumbar disc which would typically affect this nerve is the L5/S1 centrally. There is no S1/S2 disc to herniate laterally to affect it.

S2 sciatica: no disc to affect this root individually. Supplies rectal sensation.

S3 sciatica: no disc to affect this root individually. Supplies rectal sensation.

S4 sciatica: no disc to affect this root individually. Supplies rectal sensation.


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I do not think your spinal problems are related to Gorlin Syndrome...I would think they are independent of each other, but I am not a doctor...just a simple layperson with an interest in all of this and a fellow sufferer of spinal problems....


Gorlin Syndrome is a condition which can cause many different signs and symptoms. Patients can present to different specialists, depending on the first sign of the syndrome. A study in the North West of England showed that it affects 1 in 55,600 people.

The syndrome has been given several different names:

Gorlin syndrome
nevoid basal cell carcinoma syndrome
basal cell nevus syndrome
epitheliomatose multiple generalisee,
fifth phakomatosis,
hereditary cutaneomandibular polyoncosis,
multiple basalioma syndrome,
The syndrome has been given several names in the medical literature because patients with particular problems were described by the specialist looking after them. The suggested name of the condition then mirrored the speciality of the doctor writing the report. Professor Gorlin suggested that it might best be called the nevoid basal cell carcinoma syndrome, although 10% of adults do not develop basal cell carcinomas (BCCs). Rather than focus on one feature of the condition, it may be better to use the title of Gorlin syndrome, in recognition of Professor Robert Gorlin's contributions, especially as parents and patients prefer not to have a name which contains the word "carcinoma".

Dermatomes of the spine....







Hope this helps you to understand better....

GJZH
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4/06 - Lumbar Fusion - L1, L2, L3, L4, L5, S1
Anterior with cages and Posterior with rods and screws.

8/17/05 - Cervical Fusion - C4-5, 5-6, 6-7 - Anterior and Posterior Fusion with plate in front and rods and screws in the rear - Corpectomy at C-4 and C-5 and microdisectomy at C6-7.

1/4/05 - Lumbar Laminectomy -L3, L4, L5, S1, S2 Obliteration of Tarlov Cyst at S2. Failed surgery!
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Unread 11-18-2006, 10:38 PM   #3
GinaMarie
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Thanks sooooooooooo much GJZH!!!

That was so helpful. I would love to print it out but my "newer" printer isnt printing black out well. I'm going to try to find my old MRI and film reports to compare to these. My former primary care also had me listed as having general osteoarthrosis.

Thanks again.
I like your rose avator.
Gina Marie
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GinaMarie - Basal Cell Carcinoma Nevus Syndrome (BCCNS) also known as Gorlin Syndrome, Multiple other stuff, Mother to 4 miracle boys.
Nathan - Adhd,
Caleb - Adhd,
Adam - BCCNS, Adhd, Chiari Malformation,PDD-NOS
Noah- BCCNS, Adhd, Chiari Malformation, Bronchial Stenosis, Asthma
Thank you Jesus!! He walks with us thru all of this because he will never leave us nor forsake us!! He is my BESTEST friend!!!
.

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