Update: MRI 9/17/2009

Well, there is much to tell about my MRI adventure today.

First, the results. The MRI proved to provide more questions than answers, which is unfortunate. Whether or not spinal surgery is in my near future is now uncertain. The MRI revealed a definite narrowing of the central opening of the vertebrae around the spinal cord in both the cervical and thoracic regions. The surgeon described the findings as a "fair amount of spinal stenosis." However, he stated that the stenosis, while generalized and extensive, did not appear severe enough to be the source of my current pain and deficits in left arm function.

My surgeon explained that spinal stenosis can be associated with a narrowing of the space around the spinal cord, called central stenosis; but it can also be associated with a narrowing of the "side holes" along the vertebrae where the nerves go out into the periphery of the body (like the arms), which is called foraminal stenosis. Compression of the spinal cord or the nerves radiating from the cord can occur in either case. While the doctor did acknowledge I may suffer from both problems, the MRI did not clearly indicate this to be the case. To complicate matters, the quality of the MRI was disappointing. He graded the MRI quality at a B-, not a good grade for this kind of problem. This means that I may need to repeat the MRI and undergo the risky anesthesia process again. It's not something I would like to repeat!

The bottom line of my case, however, is my surgeon does not think the MRI revealed significant enough stenosis to explain my particular constellation of symptoms. He appeared very disconcerted by this, and wants me to undergo more tests. He has therefore referred me to a neurologist for further testing of my nerve function. If all goes well, I will see her on Monday or Tuesday, and will undergo evaluation, plus an EMG, to test the nerve function in the muscles of my left shoulder, arm, and hand. I can look forward to lots of little electric shocks in my arm next week! Oh, goody! :-(

So, what's wrong with me? Well, the surgeon thinks that there may be one of three causes of my pain and left arm disfunction. 1) Nerve compression due to the stenosis or some other cause (as originally diagnosed, but which will require a follow-up MRI to confirm); 2) some kind of demyelinating process in which the nerve sheaths are being damaged (like Multiple Sclerosis, which he thinks is not very likely, but is a remote possibility); and 3) diabetic plexopathy, which would then be the cause of some kind of inflammation of the nerve roots, thereby affecting my spinal cord and left arm. It's hard for me to believe that #3 is the case, since the onset of my pre-diabetic condition is fairly recent, and my symptoms have been slowly progressing over many years, but I'm no expert. Multiple Sclerosis may be unlikely, but that does not mean that some kind of progressive demyelination is not occurring; again, not good. So, I'm kind of in limbo again. It's strange, though; what I was dreading, cervical stenosis, is now my "first choice" of neuropathies among the three possibilities!!!!

Now, to the technical stuff for my medical friends. The surgeon described my condition as "polyradiculopathy." That's a fancy word for "varied" kinds of nerve "damage" in my shoulder, arm, etc. In addition to a moderate "generalized central stenosis" of both the cervical and thoracic areas of the spine, the surgeon noted a pronounced atypical kyphosis (forward curvature) of the thoracic spine. He noted that this could be genetic or due to osteoporosis, but did not notice any other lesions related to this. As he pointed out, there is no surgical treatment available for this, and it's probably not needed anyway. It is certainly not the cause of my current problems.

After the surgeon reviewed the MRI, he repeated the neurologic exam on my left arm, to attempt to differentiate the nerve impairment and determine specific vertebral involvement. From his repeat physical exam he found the following damage:

C5 - reflex "slightly present"
C6 - no reflex at all ("not working")
C7 - decreased reflex
C8 - minimal reflex
T1 - also impaired

Essentially, the nerve bundles that come out of these cervical and thoracic vertebrae provide the motor function to my left arm. All of the nerve bundles coming out of C5-T1 demonstrate significant impairment. But the MRI did not definitively reveal WHY this is the case. So, he wants to do MORE tests. On the bright side, at least he's actively searching for answers.

So, the bottom line is that I definitely have generalized cervical and thoracic stenosis (from C2-T7), much worse for my age, but perhaps not to the extent to explain my particular constellation of symptoms. I must endure my pain a while longer.

As an aside, I'd like to share a little humor about all this. As I stated in previous communiques, I am unable to endure an MRI while awake. So, I required general anesthesia for today's procedure. Well, before the MRI, I was taken to the surgery pre-op area to get ready for general anesthesia. Not one, but THREE anesthesiologists had to take care of me, not because I was anxious or difficult, but because the anesthesiologists were uncomfortable with my procedure. They even tried to talk me out of undergoing general anesthesia, because they felt it raised my level of risk too high. As one of the anesthesiologists put it, I was at greater risk than ordinary surgery because they couldn't be in the room with me as the MRI was taking place. I thought it was kind of funny that the doctors were more concerned than I was, and that it took THREE anesthesiologists to get me through one MRI! My sister pointed out that they probably gave me the same drug that killed Michael Jackson; she was right! One of the four anesthesia drugs they gave me was Propatol! And to think I may have to go through this once more!

Well, in conclusion, I came through the MRI and recovery okay. I didn't expect anything different. I was groggy and a bit slow in recovering from the anesthesia, but I'm back to normal now. My pain is still there, but I'll manage. At least, the search for answers is still ongoing, and hopefully, I'll find the right ones soon.

Thank you all for your prayers, well wishes, and compassionate concern!

David Adcock
College Station, Texas