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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1985
Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Question: based on this MRI reading do you recommend surgery

Customer Question

Question: based on this MRI reading do you recommend surgery and if so on which vertebrate? Should I not continue to work and instead collect SS disability?
C1/2 & 2/3 good
C3/4 posterocentral disc hern. which indents the ventral thecal sac. Mild caudal extension. Herniation 2.5 mm beyond disc margin. Cord impingement. Mod. to severe foraminal stenosis bilaterally.
C4/5 broad-based bulging annulus with flattening of the ventral thecal sac. Mod. to severe foraminal stenosis bilaterally.
C5/6 posterocentral herniation with flattening of the ventral thecal sac and the ventral cord. Hern. 2.1mm beyond disc margin.Severe right and moderate left foraminal stenosis.
C6/7 right paracentral hern. and a broad-based disc bulge and flattening of the ventral thecal sac. moderate foraminal stenosis bilaterally.
C7/T1 good
****Straightening of the normal cervical lordosis is present.****
T1/2 and T2/3 both good
T3/4 & T4/5 Anterolisthesis on both with loss of disc height
T5/6 Anterior bulge and spondylosis displaces the prevertebral soft
tissue with loss of disc height and hydration
T6/7, 7/8, and 8/9 all have disc herniations as well as loss of disc height and hydration most prominent anterior within the disc
all with moderate stenosis.
T9/10, T10/11 loss of disc height & hydration most prom. anterior within the disc.
T12/L1 disc hern. produces mild central stenosis
L1/L2, L 2/3, L3/4 all good
L4/5 Broad-based disc herniation in combination with hypertrophy of the facets and ligamentum flavum indents anterior thecal sac producing moderate central and bilateral lateral recess stenosis with compression of bilateral L5 nerve roots and bilateral neural foramen stenosis. Herniation appears to compress the bilateral L5 nerve roots. Post traumatic etiology cannot be excluded.
L5/S1 Slight grade 1 anterolisthesis of L5 on S1 with bilateral chronic appearing L5 spondylolysis. loss of disc height and hydration. Diffuse circumferential disc bulge with posterocentral disc herniation effaces ventral epidural fat indenting anterior thecal sac. Hern. extends superiorly from disc space by several mm's consistent with extrusion seen in sagittal image. Neural foramina are stenotic bilaterally most stenotic on the left. Post traumatic etiology cannot be excluded.
**Thoracolumbar Levorotoscoliosis noted may be associated with underlying muscle spasm, strain or sprain, or musculoligamentous injury.
Submitted: 10 months ago.
Category: Neurology
Customer: replied 10 months ago.
please also explain in layman's terms my MRI and if you recommend surgery, what type of surgery has been known to be the most successful. I have constant pain in my lower back and cannot sit or stand more than a half hour at a time before I feel I have to lay
down. When I turn... you can feel to touch and hear my thoracic area making a noise if there were several bones rubbing together at the same time and it always hurts. Laying down helps take the pressure off my lumbar area but I still wake up with pain every morning.
Customer: replied 10 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. David replied 10 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 10 months ago.

how old are you?

looks like the majority of your problems are at L4-S1

you may need from L4-S4 multi level laminectomy and diskectomy and spinal fusion in your lower back to take disk pressure off of the nerves in your lower back and to open up wider channels for your nerves to travel in the lower back and out of the neuroforamen.

you should see a spinal surgeon for your lower back issue.

Customer: replied 10 months ago.
Is thst an additionsl $50 on top of the 48? Because I expected u to explain my MRI snd brake it down so I understsnd it. Doctors today are always in a rush and don't take the time to answer the patients question so that the patient understands what's going on with their body and this can make an educated decision on how to proceed. please finish answering my question it is not complete to my satisfaction
Customer: replied 10 months ago.
what about finishing explaining to me the rest of the question which was " I would like you to explain in layman's terms what the MRI reading means. You have addressed the problems with the lumbar region but what about all the pain I am having in my mid back. I did see a spinal surgeon and he did not want to do all that to my back and barely spoke to me about my MRI just that he wanted to do surgery on L4 on L5 and L5 on S1. He won't even touch my thoracic area. What about my cervical and thoracic area any opinions about that?
Customer: replied 10 months ago.
When you suggest spinal fusion in my lower back to take pressure off of the nerves in my lower back which vertebrates are you talking about should be fused?
Expert:  Dr. David replied 10 months ago.

you most likely will need fusion from L4-S1

Expert:  Dr. David replied 10 months ago.

disk herniation means the disk between the vertebral bodies have slipped out of position.

there is 2.5mm which is a small disk herniation at C34 in the upper neck.

Expert:  Dr. David replied 10 months ago.

the neuroforamen are the holes next to the spinal canal where the nerves exit out of the spinal canal.

this narrowing can be helped by a laminectomy and diskectomy.

a laminectomy removes bone on the back of the spinal canal to allow more space

and diskectomy removes part of the disk which is pressing on nerves.

Expert:  Dr. David replied 10 months ago.

you have some severe foraminal stenosis in the C34 level, C45

and severe on the right at C56

you may also need spine surgery in your neck as well to take pressure off of nerves exiting the spinal canal in your neck which can cause weakness and numbness in your arms.

Customer: replied 10 months ago.
I am 59 years old and have worked as a CNA but I cannot do that any longer. The last patient I tried to lift I literally could not move even after I positioned my knees against the bed and had to ask my coworkers to help me. I cried because something like that never happened to me before. I am usually a very outgoing , and active women. No more! I was told that working on the thoracic area is very risky because of the spinal cord but that the spinal cord does not run down or is not close to the lumbar region is this true
Expert:  Dr. David replied 10 months ago.

the spinal cord ends at L12 level at the conus medularis and turns into hairs of nerves called the cauda equina or horse tail nerves which go through the canal and exit out of the neuro foramen in the lumbar and sacral spine.

Customer: replied 10 months ago.
why did every lawyer I talked to refused to take an MRI of the thoracic area? One said it was because the insurance companies do not recognize injuries to the thoracic area because as people get older their thoracic area degenerates and there is no way of proving that it was caused by a car accident. Did you ever hear that before?
Expert:  Dr. David replied 10 months ago.

spinal issues in the thoracic area which can be repaired by surgery are less common than problems in the neck or lumbar spine

which can be fixed by surgery

Customer: replied 10 months ago.
waiting since 9:56 where did you go? Now 10:05 est
so does that mean because it is less common they should ignore it. As I sit here and type my mid back is hurting like crazy. You have review and sent your opinions on the lumbar, then cervical but not the thoracic area please look it over and tell me about what you see in my thoracic area according to my MRI and what would you do if anything if I were your patient complaining about lifting things and pain in my mid back
Customer: replied 10 months ago.
Reading again what you wrote above you stated that the spinal cord ends at L12 problem is there is no L12 lumbar only goes down to L5 then S1 hummmm.
Customer: replied 10 months ago.
please explain
Expert:  Dr. David replied 10 months ago.

the findings on the T spine are not as severe on the MRI scan

that doesn't mean you don't have pain from there.

you may benefit from a TENS unit on your thoracic spine to help decrease pain.

have you tried a TENs unit so far?

Customer: replied 10 months ago.
didn't help on my thoracic area and when used on the cervical are I felt nauseous
Customer: replied 10 months ago.
I guess my thoracic area hurts because it looks like this:5/6 disc bulge
6/7 herniation
7/8 herniation
8/9 herniation
12/L1 herniation
Customer: replied 10 months ago.
no surgery there what about hot or should I use cold compresses
Expert:  Dr. David replied 10 months ago.

the surgery in the thoracic spine would be too long, the fixation would be too long and difficult and you would loose too much mobility.

hot packs on your back can help relax muscles in your back

cold or ice packs can help decrease pain and inflammation

you can alternate them and see if that helps your back

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