Spinal cord compression can be painful and a real challenge to figure out sometimes. Often I will have patients report to me that their shoulder blade pain will get worse over the course of the day. Common is also the report that the symptoms get better when they are lying down.
In a recent case, the patient was determined to find the problem in Nanaimo and traveled to the Welcome Back Centre in Kamloops to obtain an upright MRI. This is something I advised to do because I believed, based on the history, nothing significant would show up with conventional lying down MRI.
Here were the results.
Upright on the left and lying down MRI on the right.
Most noticeable is the spinal cord compression.
Disc bulging and ligamentum flavum folding seen.
If the patient were to have undergone a conventional MRI, the report would have been ‘normal’. This is an example of when to consider an upright MRI. Also, one has to suspect a disc compression problem especially when someone reports that their symptoms get worse as the day goes on.
It is unfortunate, that when the upright MRI was introduced to market, the non-musculoskeletal radiologists began to report on the reduced resolution of the MRI unit. And since then, this type of knee-jerk reaction seems to be the first response. But for spine, it is an invaluable source of information and the clinical trick is WHEN to order it.
Recently, real-time MRI showed how the discs can change under sustained traction. The evidence is starting to mount on how we can help these types of cases.
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