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Help with son's MRI report

PeggyMPPeggyM Posts: 129
edited 06/11/2012 - 8:40 AM in Back Surgery and Neck Surgery
Mods, please feel free to move this if this isn't the appropriate place for it.

Hi Everyone,

My son has finally had the time and energy to scan and send his MRI report to me and his would-be surgeon.
Just thought I would put it on here and see if anyone has any idea what his surgeon is going to recommend. He has picked a well known fellowship trained spine specialist to do his surgery as he can't tolerate the pain any longer.

Sorry this is so long but as you can see he has multiple issues. A Positional MRI was used to better show his spondylolisthesis.


T2 sagittal flexion, as well as extension views of the cervical spine were obtained with the patient in the seated position in the open MRI scanner.

There is straightening of the mid to lower cervical lordosis suggesting muscle spasm or sprain. The disc space heights are preserved. Vertebral body heights are maintained. Vertebral marrow signal is unremarkable. The cervical cord and visualized posterior fossa structures are unremarkable.

The C2-3 disc is unremarkable. C3-4 shows broad disc bulging along with some uncovertebral spurring. Bilateral foraminal stenosis occurs. At C4-5, there is a central/left paracentral disc protrusion which impinges on the spinal cord and producing spinal stenosis. Broad disc bulging and uncovertebral spurring are superimposed and foraminal stenosis is on the left. At C5-6, a left sided disc bulge with an annular disc tear indents the thecal sac and approaches the cervical cord. C6-7 has a central and left sided disc protrusion with an annular disc tear. Mild broad disc bulging and uncovertebral spurring are superimposed. Foraminal stenosis is on the left and there is mild spinal stenosis. C7-T 1 has a right sided disc protrusion which impinges on the spinal cord. Tl-2 disc is unremarkable.

1. Disc protrusions are seen at C4-5, at and to the left of midline, on the left at C5-6, C6-7 and to the right of midline at C7-Tl. Disc impinges on the spinal cord at these levels.
2. Disc bulging is seen at C3-4 to C6-7.
3. Foraminal stenosis is on both sides at C3-4, on the left at C4-5 and on the left at C6-7. Clinical correlation is recommended for corresponding radiculopathies.
4. Straightened cervical lordosis suggests muscle spasm or sprain.


With the patient in the seated position, Tl and T2 sagittal imaging of the thoracic spine was
performed along with T2 axial imaging obtained through the disc spaces. No contrast was administered.

There is straightening of the overall thoracic kyphosis suggesting muscle spasm or sprain. The disc space heights are preserved. Vertebral body heights are maintained. Vertebral marrow signal is unremarkable. The thoracic cord and conus are unremarkable.
There is no fracture or spinal stenosis. No disc herniation or paraspinous mass is seen. Disc bulging is visible at T3-4 on the right. The other thoracic discs are intact.

1. Straightened thoracic kyphosis suggests muscle spasm or sprain.
2. Right sided disc bulging at T3-4.
3. No disc herniation or spinal stenosis.


High-field open MRI imaging of the lumbar spine was performed with this patient in the seated position. Sagittal T1 and T2-weighted imaging of the lumbar spine was obtained along with T2 axial imaging through the disc spaces. No contrast was given.

There is a grade I spondylolisthesis at L5-S 1. Disc space narrowing and desiccation are present. There is10 mm of forward subluxation. The other disc space heights are preserved. Vertebral body heights are maintained. Vertebral marrow signal is unremarkable. The conus is unremarkable and ends at TI2-Ll. The T12-Ll and Ll-2 discs are unremarkable. L2-3 has mild broad disc bulging. L3-4 also has a mild broad disc bulge. The L4-5 level shows broad disc bulging as well. At L5-S 1, a large broad disc bulge is associated with the spondylolisthesis. Bilateral severe foraminal stenosis occurs. No spinal stenosis is seen.


1. Grade I spondylolisthesis at L5-S 1 with 10 mm of forward subluxation.
2. Broad disc bulges are at L2-3 through L5-S1, largest at L5-Sl.
3. Bilateral foraminal stenosis at L5-S 1 so clinical correlation is recommended for corresponding radiculopathies.

Thanks for any advice or thoughts or anything you think could help him. He is so afraid of surgery and being worse off than he already is but just can't bear to spend his life in pain. He has two little boys who depend on him to take care of them on a daily basis.

Peggy x



  • Just spoke with him and he says that even though his cervical issues seem to be the worst of his problems, it is his lumbar area that is causing him the most pain at this time.

    I'm amazed that he isn't having pain problems with his neck although he certainly has had in the past.

  • It is evident from the report why your son is in so much pain...but, where to start? Usually a surgeon will work on one area at a time unless the situation is a scoliosis. My guess is that the most urgent situation is in the cervical area where the report indicates that from C4 to C7 the discs are bulging and pressing into the spinal cord. When there is pressure on the spinal cord, the doctor usually wants to take care of that situation first...and this would be the cervical region.

    The lumbar area also has issues that may also be causing nerve compression that results in radiculopathy. The spondylolisthesis at L5-S1 means that there is instability in this spinal segment. One vertebra is sliding over the top of the adjacent vertebra, causing it to be off-set by 10mm. This is not a huge amount...grade I is the least amount in the grading system...it can slide much more and this is the worry. Surgery is often performed to keep the slipping from going any further and to stabilize the spine. The broad disc bulges that are seen from L2 down to S1 may or may not be pain generators. Just because a bulge shows up on MRI, it does not mean they are causing pain.

    I noticed the MRI was done with your son in a sitting position. Do you know if he has a MRI done in the more standard prone position? The sitting positional MRIs are generally less clear as the machine is less powerful and it is open so there is more "scattering."

    Was your son in an accident of some sort?

    I'm glad he has found a spinal specialist and hope that this doctor can help him.

  • Just seeing your further information -- well, if they start at the lumbar area, the doctor will probably recommend fusion. With a spondylolisthesis, if it is determined there is instability, the only solution is a surgery to make this spinal segment more stable. Often this is a fusion with hardware....there may be some new technique that your son might be eligible for. But the idea is to stabilize the spine. When there is slippage it creates wear and tear on other spinal segments. It can also pinch a spinal nerve which results in the referred pain, sciatic-type pain, that runs down the leg, sometimes causing numbness, etc.

    Read more here: http://www.spine-health.com/video/spondylolisthesis-symptoms-causes-and-treatment-options-video
  • I agree with you that he is probably looking at a fusion. It would be fantastic if just taking care of the spondylolythesis would solve some of his pain issues, but from the sound of his report he will have to address his cervical issues at some time in the near future.

    Seems to me that starting at the bottom and working your way up the spine would be the way to go with spine surgery (unless of course you have scoliosis, which he says he was told he has by another neurosurgeon). The weight of the hardware has got to take it's toll on the rest of the spine.

    I know that from the report he needs to hydrate his discs as much as possible and worry that he doesn't drink enough water every day. Thank goodness he doesn't smoke! I keep trying to give him hope that he will get at least some part of his life back but I know he struggles every day with feeling inadequate and worrying how he will cope after surgery.

    My plans are to go and stay with him for at least 3 weeks but because I live in England and he is in Florida I will need to take a leave of absence from work to help him and take care of my grandchildren while he is incapacitated. My boss is recovering from carpal tunnel surgery and has been off since before Christmas and is not expected back until Feb 1st. He also has gall bladder issues and is looking at surgery for that in the near future! So this all needs to be properly planned!!

    So, he stresses, I stress and somehow we manage to get through day to day life. It is so very difficult being so far away from him. He is my only child (it doesn't matter how old your kids are!!)and it breaks my heart to see him suffer so. Thank goodness for Skype and good calling plans!!

    Thanks again for your thoughts.

    Peggy x
  • Be very sure that your son finds a top-notch surgeon. It is always a good idea to get several opinions. I think it is especially important to be careful in Florida. In part, due to the large population of retired people, they have more than their fair share of mediocre doctors...and, also clinics that advertise too-good-to-be-true procedures. You have to be very careful to do your research.

    Sometimes people have a spondylolisthesis that is only discovered after having imaging tests or X-ray for another purpose. It does not cause any issues of pain or instability.

    Having something pressing into the spinal cord can be, potentially, a much more serious situation.

    Guess you'll just have to rely on what the spinal specialist tells your son.

    Good luck and please let us know what happens.
  • Sorry I forgot to answer your question about whether my son was in an accident. Yes, he was in a bad car accident when he was 19 and then a couple less serious ones. The neck problems started when he slipped and fell in a convenience store and fell so hard on the back of his head he was knocked out for a few minutes. At that point he was having some real issues with his back but after the fall he really started to deteriorate and the neck problems started.

    He has had many opinions from surgeons all around Florida but didn't feel quite ready for the surgery and the neuros couldn't seem to agree on which way to go...cages, no cages etc. So he had no confidence in anyone.

    I spent many hours checking out doctors for him and with the help of Spine Health spineys I finally found 2 doctors that I think know what they are doing! One is very qualified and is fellowship trained and the other has a huge spine centre, is also fellowship trained and does nothing but spine surgery and is very highly rated.

    So these 2 are who he has decided to go with. Hopefully they will both agree on what will help him.

    Thanks again Gwennie for taking the time to write. I really appreciate it and I know my son does too. Hopefully he will find the strength to come on here one day and thank all of you himself!

    Peggy x
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