Hiya.

Most of my issues are si & lumbar, but I just had a cervical & thoracic MRI and was wondering if some of you vets could tell me what the heck this means? I could look it all up of course, but I sure do love laymen terms & friendly "it's all mild, you're fine!" better than what I'll find on the net.

And it does say mild a few thousand times, so that's good.

The parts that have me stumped are bolded. THANK YOU IN ADVANCE for your help!!!!!!!!!!!!!!!

T4: The bone marrow signal is unremarkable. No acute thoracic fracture is identified. No spondylolisthesis is visualized. No syndesmophytes are identified. There is mild spondylosis anterolaterally at T8-9, T9-10 and T10-11.

There is moderate disc desiccation at T8-9 and T9-10. Blah, blah. There is a 2.4 mm central disc protrusion at T9-10 which mildly impresses on the thecal sac. No disc herniation or spinal canal stenosis is seen at the remaining thoracic disc levels.

C2-3: Mild disc desiccation is noted.

C3-4: Mild disc desiccation is noted. There is a 2.0 mm broad-based disc protrusion which mildly impresses on the thecal sac. The protrusion measures 1.4 mm in flexion and 2.2 mm in extension. No neural foraminal narrowing is visualized.

C4-5: Mild disc desiccation is noted. There is a 2.0 mm broad-based disc protrusion which mildly impresses on the thecal sac. The protrusion measures 1.4 mm in flexion and 2.2 mm in extension. No neural foraminal narrowing is visualized.

C5-6: Mild disc desiccation is noted. There is a 2.0 mm broad-based disc protrusion which mildly impresses on the thecal sac. The protrusion measures 1.0 mm in flexion and 2.0 mm in extension. No neural foraminal narrowing is visualized.

C6-7: The disc hydration is within normal limits. No disc herniation, spinal canal stenosis, or neural foraminal narrowing is visualized.

Holly, med-speak often makes my brain twitch, but I googled 'anterolaterally' and I'm wondering if they mean 'squaring' of the thoracic vertebrae (ie. the sides fill in so instead of being sort of hour-glass-shaped the vertebrae are more rectangular). I had that on the first set of x-rays back in 2001.

I also googled 'thecal sac' since I hadn't a clue:

The thecal sac is a spot in your spinal canal. It has the cauda equina, spinal fluid and spinal cord in it. It is a membrane that is around the spinal cord.

So, it sounds like the protruding discs are pressing on the sac that protects your spinal chord?

Dear god, I think I just developed another twitch.

Hope someone else can help more. One day, you'll surprise yourself by actually knowing what they're saying without asking.

Warm hugs,

Sorry to make you twitch Kat. ;-) Thanks for the help. I did google a bit before I posted, but it seems like one term leads to another to another and another...

Most of my problems are si / lumbar, so I'd be surprised if someone comes back and says any of this is a big deal. I mean, my neck and upper back hurt a lot, but nothing like my si & lower back. She sent me because of the numb arms & dropping things. Well, and because I said my neck hurts. ;-)

It really can be like some perverse, convoluted puzzle, can't it.

I hope they at least can see their way to helping you because of these results. There is stuff going on most definitely and with the neck vertebrae (those are the ones labled 'C4' or 'C5' etc.) mildly impressing on the spinal cord protection, that might explain the numbness. Maybe???

I was getting numbness and tingling in my pinkie fingers and pain that shot down from my shoulder, through my elbow into the outside of my hand. I'm relatively certain that was ulnar nerve related. It was rather troublesome because I type for a living. Gotta use the pinkies when you type and I kept missing the key or didn't have the strength to push it down when I hit it! Luckily, switching biologics helped (because Remicade wasn't working as well, so I went to Enbrel). I still get it every so often, but nowhere near as badly as last year.

Warm hugs,

I emailed a very good friend off the board with the report too and he replied back with some great layman's terms for me. He said:

You're fine.

So that'll work for me. And just to reiterate, my AS related stuff is si & lumbar. That's where all of the magic is happening. Those reports are super easy to read. They say, "you're screwed."

This cervical / thoracic is all just fun bonus stuff. Sounds like when my pain is under control and I can work on my posture, I'll be fine, just fine.

That's a relief.

I have lumbar and SI as well, but also thoracic and (maybe) neck, and last year my Achilles decided it wanted to play too. Yay.

Don't you just love this game?

Warm hugs,

Ha. No. :-)

Me either, you two...let's play something else for awhile...don't you wish it were that easy?

Spondylosis is the Big Word for degeneration of the spine - i.e.: wearing out! Antero-lateral means towards the sides and front of the vertebra. In the thoracic spine this is because this curve in concave to the front, so that's where the wear & tear is usual...

Dessication (drying out and therefore loss of height or disc space...)of the discs also indicates aging and degeneration and that's what causes the bulging of the disc material into thecal sac (which as Kat said is the lining of your spinal canal) - the fibrous ring around the outside of the disc is aging too. Loss of disc height will reduce the cushioning effect and hasten the spondylosis too.

In other words, from this sort of report, this physio is convinced that your avatar is some gorgeous young chicky babe whose pic you stole off the internet and you are in fact 20 years+ older and probably have wiry grey hair and loads of wrinkles!

Yikes, Holly! If in fact you are that gorgeous smiling blonde babe with young kids then you are definitely showing very early signs of degeneration... perhaps not surprising given that you have an AS diagnosis, tho'...

This sort of degeneration is not likely to be the cause of spinal nerve impingement (no evidence of this sort of finding on the MRI) and therefore to be the cause of you dropping stuff, Holly. (IMO - remember that I am basing this purely on your MRI report....I would be assessing muscle power, sensation and all sorts of other things if you were in my rooms and I was not being a 'virtual' PT!)

Hi Holly!

Disc Desiccation is the drying out of the discs. It is a degenerative process. It happens to everyone to a degree over time. If you look at your discs on an MRI they should be light and full. As discs begin to wear out they will look gray and be smaller. The space between your vertebrae will be shorter. Disc protrusion means that some of the jelly-like center of the disc is protruding out. It is a disc herniation that allows the disc material to come out. Think of a disc as a shock absorber with a tougher outside layer and jelly-like material in the middle. The thecal sac is a membrane on the spinal cord or spinal nerves. Your MRI means that that disc material is leaking out of the disc and touching the thecal sac. A lot of people have herniated discs that aren't causing any symptoms since the disc material isn't touching anything. Some people have a lot of problems because the material is impinging or compressing a nerve. It sounds like you are in the middle. The material is touching your spinal cord or spinal nerves but not compressing them. Spondylosis is a type of degenerative osteoarthritis in the spine. Anterolaterally would be the location on the particular levels noted (T-8 through T-11). I hope this helps!

Craig

Er, not quite.... disc bulging is from degeneration in the strength (integrity) of the annulus fibrosis, rather than herniation, which is when the jelly-like substance is leaking out through a tear in the annulus. The nucleus pulposis could be thought of as caustic, if you like, and will cause massive inflammation in structures that it touches. Then in addition to that it may compress the theca enough to cause spinal canal or spinal nerve root compression and therefore neurological symptoms.

The disc material(or even the annular bulge)is NOT touching the spinal nerve roots or spinal cord in Holly's MRI. No significant indentation of the thecal sac is evident, let alone pressure on neural structures.

Sorry to be anal, but there's a huge difference between signs and symptoms of disc bulges and disc herniation...

(Off my soapbox now...)

Well, hell. This blows.

I can't thank you enough. Truly. I would have probably gone skipping along thinking I was fine, since the pain in the upper back & neck doesn't hold a candle to the pain in the lower back!

Louise - can I trouble you with one more thing? My primary goal, once my pain is minimized, is to first work on strengthening my spine -- regaining my posture. My rheumy agrees, but do you?

Is it possible to undo some of this? Or keep it from getting worse if I can just get my pain under control and work hard, very, very hard to get my strength & posture back?

Just this morning I was trying to convince myself (again) that I don't have AS. I do that at least 2 times a day you know. Even though I do have AS. Stupid spondy monster. Grrrr.

Oh, on a happy note, thanks for thinking I'm, uh, a cute babe! It really is me in the pic, I promise. I'm only 36, and I've only had active AS for 4 years. I might have wiry gray hair under all of these funky colors I put in it, who knows. Part of why it took me so long to get diagnosed (and I know many of us go through this) is that I look so normal. Like your average soccer mom.

So, guess I'm gimpy from neck to butt now. Who knew.

Thanks again for everything. I might have a solo-pity party over here for a little while, because I'm just so angry. Feel like I just got diagnosed with something incurable, like, I dunno... AS or something.

Wait a sec -- am I overreacting? Maybe I'm reading into what you said. I'll come back tomorrow and see if I interpret it differently.

See? Soccer Mom. ;-)

By the way Craig, I didn't thank you for your reply as well.

I think when I'm sane again tomorrow, I'll re-read what you all wrote and probably react like I should have the first time. As you guys know, I'm suuuuppppperrrrr emotional.

Ha - I miss Kevin. This is when he would have chimed in to remind me that I'll never be sane, and that I never really have been. ;-)

well sorry to tell you but you'll never be sane and you never really were

Ha. Thank you. I'm smiling again now.

Michelle

Takes one to know one

Me too...I was able to get my court papers filed against BP(still can't believe I almost missed the deadline! ) ...tomorrow is the one year anniversary of the BP Deepwater Horizon Rig explosion...and WL&F announced yesterday that shrimp season will remain closed until further notice due to the new discovery of oil in our fishing zone... But...I'm still very happy that it all worked out and the papers were filed at the courthouse...whew!! close call!!

Absolutely!!! I own it too...

Can't help it...it is what it is, for now at least...

It's when you don't know it you're in trouble!!!

Bah-ha-haha!!! For true, for true, dat's da truth, c'est tout bon!!!

Oui oui, c'est tout madamoselle

Quit with the Spanish will ya?

Hahhahahhaahahahahhaa

I wonder how many people will actually think I'm that dumb. Oh boy did I just open a door or what!?!

Hasta mañana - that's French (heh) for 'nite peeps.' Dragging my gimpy butt (and neck) to bed.

hasta luego Holly

Merci beau coup, Jeffery!!! Bon soir, Holly!! et à tous une bonne nuit... beaux rêves!! ...and to all a good night...pleasant dreams

Have no idea what you high-brow multi-kulchiral people are talking about!

But my dog Sonar CAN speak French, you know....

he goes "Wee wee" EVERYWHERE!

Yup!.... regular soccer mom - aint nuthin' wrong with this babe! Just look at that smile - just doesn't look miserable so can't have any pain...

As if... or should that be "If only...?"

Holly - I didn't mean to scare you!

Remember that it said "mild"!!! It's more than you would expect to see in the average 36 yo.... but remember that I haven't seen your actual MRI films... I like to look at those *first* then read the report after, just to check that I can still read 'em!

I do agree with you and your rheumy - you need to go see a good PT. I would be assessing your posture, see what is tight and what needs to be stretched. Then I would be teaching you some postural correction techniques and getting you to work on your core strength. A good PT should be able to help with getting some general fitness work into your programme too. Of course, for this to be happening, you will need to have some good management of your inflammation and pain.

I believe there is also a place for some manipulative therapy in some folks with AS - there may well be a mechanical component to some of your spinal pain as a secondary effect of the inflammation. Like tasting lemons, the theory is "suck it and see..."

Do you swim - or at least, are you happy in water? You might find that you can get the PT to organise a pool programme for you that incorporates strengthening, stretching and fitness in the warm water of a hydrotherapy pool. The warmth can help with your pain too...

I don't think it's possible to *undo* the sort of degeneration that your MRI is showing, but you can keep all the things that support your spine strong, and that will minimise the physical effects of what is probabaly a process that has been going on quietly for some time (no)thanks to the Spondy Monster.

Don't have a lone pity party when you can have one here amongst friends - we all like a good drink and a knees up!

And when it comes to getting angry at the Spondy Monster - I say - don't get mad - get even! Don't let it win! Kick it down and then kick it hard as many times as you can! Yeah! Take that SM!

I'll post more later when I'm not trying to beat a deadline but just wanted to say thanks again and I'm looking at this differently today. Not as reactive.

Kind of a 'react first-think later'? LOL. Easy to freak out, but a bit of time after the shock and you get less freaked out. Time to get to the PT. Like Louise said, learn some posture measures and keep your core muscles strong... At least it was mild and there is room to change the outcome with some strengthening.

Hope you make your deadline!

Yes, I'm with rumble...Louise knows her business!! I would talk with her about it...

Yeah. I think sometimes even happy, smart & somewhat sane people like me (or at least, that's how I see myself) get so overloaded that they can't help but shut down mentally and react purely on instinct. I've got too much on my plate. It is overflowing. Some of you know what I'm talking about -- my marriage and work feel like they are falling apart, I struggle with how my pain affects my children, etc. Have growths on my back to be biopsied, some new funky illness to be tested for (IC), my IBS is flaring. Getting tested for MS. I don’t sleep more than 2 or 3 hours a night EVER. Blah, blah, blah. It's hard sometimes for even the goofy "smile all of the time" people like me to just get by.

So I got mad when I heard there was yet another obstacle in my way. I can overcome it (with help!) but I was just in shock and frustrated that one more thing was thrown at me. And for once, it was something I did to myself. Yes, you read that right. I made my neck & upper back gimpy. I work from the couch from 7:30 to 4 every day. I make myself get up to do things around the house, but the last time I “stretched” I pulled a muscle and ended up in the ER. That was a year ago. I haven’t stretched since and I gave up trying out of fear. So yeah…my neck & upper back = totally my fault.

Lesson to newbies -- no matter what, get your butt off the couch. In the beginning, I kept trying and trying to move, stretch, do very small-scale exercises, but would scream in pain sometimes and take days to recover. I admittedly, threw in the towel. I tried PT 3 times (one was a water-therapy PT) and all three times, I was beyond crippled by it, but mostly because they didn’t understand what AS was and had me doing things that were extremely bad for me. Once my pain is under control, I’m going to go back to PT. NO QUESTION. But to ease some of my fears, I called and asked my doctor if she would write a note that explains what I need so that they don’t cripple me worse – and so I can stick with it. I need to.

I am so glad this is all mostly mild and that I can take steps to improve. I just need a day or two to be angry about it. Then, I'll get over it, add it to the list of stuff to deal with and get back to my job of trying to move the mountains that are standing in my way. I'll move them. With help and time.

Louise - you are awesome. I'll reply more later. I do have a huge ghetto pool – “Holly speak” for above ground monstrosity in my backyard - that I can use! It isn’t heated, but I’m in Texas so it won’t really be cold for long – once I know what I’m supposed to do, I’ll do it. And I want to start slow. I tend to jump in with both feet and overdo it with everything in my life. I think the key here will be to do a little each day until I’m stronger, then add to it. I’ll even join the KickAS fitness club.

Rumble - I made the work deadline. Whew. But now, I have to find a way to get my butt to my 6 year old's violin concert. He is 1st year, but has already caught up to the 2nd year kids and will be the only one in his class to stand up and play the songs the 2nd year kids are playing. One of the few things I do these days is work with my kids musically and artistically (we play a lot of instruments around here, and I'm an artist by profession -- it's easy to get them interested). So I can't wait to see him up there playing, knowing that even when it hurt like heck, I helped him practice and that I'm part of why he'll be beaming with pride. And I will be too, of course. My kids are the best part of me, and the very best part of my life. ;-)

I'm rambling, but I'm still sort of a mess today (obviously). I mean, duh, I knew I had AS though I try to deny it. But I kept thinking once I got back on biologics and got my pain under control, I'd get better -- that only the small amount of damage that was already done would be with me forever. It devastated me to know there was any more damage, even if it was mild. I HAVE to get back to being me, full time. I'll work my tail off to get there. I just need a day or two to be angry about it, I guess. And learn to accept it all over again.

Thanks again. I'll post more later. Less rambling, hopefully.

i couldn't help but notice your story about your pulled muscle from "stretching"; i thought i was the only one who did this (til i heard others on here share similar); tore my rhomboid this way, tore the IT/TFL bands this way. but was lucky to have PTs that knew first you have to let it heal, help it heal with things like heat/ice, ultrasound, etc. then once its out of the accute stage, then you do the gentle exercises, and if the exercises flare it, you go back to the healing stage. was lucky in both cases. and for me it took many years (and its still not right) for the rhomboid to get better and a year for the IT/TFL bands to get better.

i've had other PTs, that basically just did exercises that would try to do too much before my body was ready, and each time it would only make it worse.

but i've found these things (for me at least) really don't recover on their own. i need PT to fix me, but gentle and slow, like i described above.

i think its a matter of finding the right PT, someone like louise!
finding someone who calls themselves a manual physical therapist might be a place to start.

now i can often fix these things myself by following what i learned in PT, but no way could i without all those years of PT.

PS and please don't blame yourself, no way for you to know, and you did try, you went to PT, not your fault that it made things worse. that's a shame that that happened, it didn't have to, but a good PT should be able to help you gain your muscles' strength back i would think. i was amazed how far things could be turned around for the good; like a neck so weak it was almost constantly in spasming to one that is much better now, and only acts up in flares.

i've learned that another thing that contributes to desiccated discs, of which i have a few, is muscle imbalances.

Thanks Sue.

I'm too tired to write more but for now... Thanks. :-)

thanks is more than enough!

Not a problem Louise! I am far from an expert!

Awwwwwwwwwwwwwwwwwwwwwwwwwww!

Oh, the Awwwwwwwwwwwwwwwwwwwwwww! was because of the cute soccer mom pic!

You are welcome Holly! Anything to help!

Craig

holly, aloha

just one question pops to mind...if your major problem area are in SI and lumbar...why did he look at evrything else?

Hi Ben. Because I've been dropping things (a lot), my arms keep going numb to the elbow (which might be because my hands are always clenched in fists) and because I said my neck hurt.

Why do you ask? Is it uncommon for a rheumy to order an MRI for an AS patient with neck pain? Maybe she is even more proactive than I thought ...

By the way Ben, I didn't mean that rudely. Just in case that is how it came across I wanted to let you know I'm genuinely interested in your answer.

Thanks!

holly, aloha

one thingee doctors often want to do with MRI's is look at deterioration of the principal areas of prior complaint- it's a way of evaluating disease progression...before/after photo's.
maybe i'm missed the nature or extent of your 'new complaints' which certainly might pique your physicians interest...

i've never had an MRI, i've had successive xrays of certain areas which showed how bad things got to in si and lumbar...mri's are a lot more expensive than xray and use more radiation, which is a concern btw. many, many doctors own their own mri machine's and because insurance will pay and profit is high, well they order mri's.

i just wondered if/ why perchance since you have significant existing lower back stuff he didn't look at it all at once.

oh but then he can order and bill for another.

i take a very significant and critical view of any med professional who can't get it- this is and episodic and progressive condition...i oversimplify but 'it's all good' and it's all really just the same stuff moved somewhere else.

sorry i took so long, been busy
aB