Unread 04-01-2009, 10:38 PM #1 (permalink)
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Default Most recent MRI of the thoracic spine (Wright?)

I'm hoping to have someone decipher this a bit more clearly. The neuro that ordered this acted like the cold leg is significant, the pins/needles is significant, the purple foot is not, the reaction to anabolic steroids is significant, and the findings on the MRI could be significant but he won't rule out als and won't recommend un-necessary surgery to correct this herniation. WHY WON'T THEY FIX THIS? Again..I think it's because it's only un-necessary if he has als....even though this in combination with his stenosis and fusion and 2.5 yrs of compression could be causing his condition....in any other person walking in with this herniation plus neurological conditions, surgery would be recommended immediately.

Anyone have any takes on this MRI?

Thanks!
Tracy

1. Sagittal T2, STIR, and SPACE, including dedicated high resolution sequences
2. Coronal SPACE
3. Axial T2 and diffusion tensor imaging, including color fractional anisotropy maps
4. Additional high resolution thin section axial T2

FINDINGS: The alignment of the thoracic spine is normal. There is multilevel degenerative change, with loss of disc height and signal particularly mid to lower levels. A focal central disc extrusion is present at T6/T7 that exerts mass effect on the adjacent thoracic spinal cord. The sagittal T2 and STIR images demonstrate very subtle increased signal in the ventral portion of the cord adjacent to this disc extrustion, although this finding is not confirmed on the axial images.

The thoracic spinal cord otherwise demonstrates no intrinsic signal abnormalities. The diffusion tensor images do not show localized decrease in anisotropy or diffusivity.

The vertebral body bone marrow demonstrates no suspicious signal abnormalities. The neural foramina are patent at all levels. T1 facet joints are normal at all levels. Incidentally visualized soft tissues of the thorax demonstrate no abnormalities.

IMPRESSION: Focal central disc extrusion at T6/T7 that exerts mass effect on the adjacent spinal cord. There is subtle abnormal signal within the cord at this level that suggests possible edema from mass effect, but the finding is not confirmed on all sequences and therefore indeterminate. No other definite abnormal cord signal is identified to correlate with suspected neurodegenerative condition.
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Unread 04-01-2009, 11:30 PM #2 (permalink)
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Hello Tracy

Basically what they are saying is that they see a disc protrusion but it might not be compressing the spinal cord enough to cause his symptoms. There might be evidence of spinal cord inflammation seen when the spinal cord is visualized at one angle but this inflammation could not be seen (i.e. confirmed) when viewed at a different angle.

Having said that: what physicians are taught to do, is treat the symptoms and not the images. There are some people out there they have severe spinal cord compression (as visualized with MRI) and walk around with absolutely no symptoms, while others have a mild compression (again, as visualized with MRI) and have profound symptoms.

I just read your previous thread where you had a new neuro want to look at your husband. Is this who conducted this MRI? He/she sounds like your best hope to get something accomplished when it comes to a possible surgery. Once that obstacle has been overcome, the next obstacle would be getting the insurance company to pay for the surgery.

If you have any other details, please share them with us and keep fighting.
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Unread 04-02-2009, 08:33 AM #3 (permalink)
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Thanks Wright!
Is it possible for that anterior spinal artery to be compressed without MRI evidence showing on the spinal cord?

His legs are frigid cold with pins and needles in his left foot..which from what I understand is a sign of lack of circulation to the area...but they won't do an angiogram to map his arterial system because they say that artery compression would show a signal change in his spinal cord on the MRI.

Should I keep pushing to check circulation? They keep looking at the cord and not "that little vein" as one condescending ortho phrased it.

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