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  • Vjenkins
    Member
    Post count: 10

    Dr. Corenman:

    It has been some time since I have been here. About 7.5 months ago I had an ACDF on my neck and all is going well there, healing nicely and bone growth going well.

    About 1 month ago I felt this “wiggly” feeling in my toe and was hoping it would go away, it didn’t, after about 3 weeks I called my neurosurgeon and the symptoms were starting to progress before the appt. time. I started having nerve pain, I explain it as branches of nerves flickering, but it hurts, and I developed numbness in my toes, then my foot, then it started in my left toe and foot. It progressed over the course of only 1 week to my hands, with slight numbness and the same nerve pain. The nerve pain is intermittent but the numbness seems pretty constant and my feet are COLD all the time and hands mostly cold as well and I have back pain as well. I went to see my neurosurgeon and had an MRI and I wanted to get your impression on the results as I will not see him for a bit. I went to pick up my medical records and I have the written report and the MRI images. Please see results below: note that I had a lumbar and thoracic MRI done:

    MRI: T SPINE W/O CONTRAST

    FINDINGS: Thoracic marrow signal is normal. There is no focal cord signal abnormality. The conus is normal, no canal or significant foraminal stenosis.

    t1-t2 minimal disc bulge, t2-t3 minimal disc bulge, t3-t4 minimal disc bulge, t4-t5 no sig. abnormality, t5-t6 no sig abnorm., t6-t7 no sig. abnorm., t7-t8 mild disc bulge with small central disc protrusion. No stenosis.
    t8-t9 minimal disc bulge, small right sided disc protrusion with some effacement of the thecal sac. No stenosis.
    t9-t10 minimal disc bulge, t10-t11 minimal disc bulge, t11-t12 minimal disc bulge
    IMPRESSION: MILD MULTILEVEL THORACIC SPONDYLOSIS AS DESCRIBED WITH SMALL CENTRAL T7-T8 AND SMALL RIGHT SIDED T8-T9 DISC PROTRUSIONS. NO CANAL OR FORAMINAL STENOSIS.

    MRI: L SPINE W/O CONTRAST

    Finding: sagittal images demonstrate mild chronic anterior wedge compression of the L1 vertebral body and mild chronic irregularity of the inferior L2 endplate with small Schmorl’s nodes. No acute compression/marrow edema. Lumbar levels intact otherwise, distal cord/conus normal.

    L1-2: mild posterior disc bulge and endplate spur slightly effacing thecal sac, but w/o sig spinal stenosis. Mild facet hypertrophy

    L2-3: no disc herniation or sig. spinal stenosis. Bilateral foramina are clear. There is mild facet hypertrophy.

    L3-4: very mild lateral recess narrowing predominately due to mild to moderate facet hypertrophy with ligamentum flavum thickening. No disc component or nerve root impingement. Foramina are clear.

    L4-5 Mild lateral recess narrowing from mild disc bulging, mild to moderate facet arthropathy with ligamentum flavum thickening. No nerve root impingement. Very mild foraminal narrowing.

    L5-S1: very mild posterior disc bulge slightly effacing the epidural space. No sig. stenosis/mass effect. Facet arthropathy w/o significant foraminal stenosis.

    IMPRESSION: MILD LUMBAR DDD/SPONDYLOSIS AS DETAILED ABOVE, NO ACUTE APPEARING DISC HERNIATION, MILD CHRONIC COMPRESSION DEFORMITIES L1 AND L2, NO ACUTE FRACTURE/EDEMA.

    Sorry for the long message, any advice you would give me would be beneficial as I’m not sure if this means surgery or not.

    Thank you and I look forward to your response.

    Also wanted to add that I’m feeling burning pain in my right thigh and right buttocks intermittently, my feet are tender and hurt to walk on.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Nerve symptoms that spread to hands and feet are called “stocking and glove” paresthesias and pain. There are many different causes of this type of symptom complex and the spine is only one of them. There are metabolic neuropathies (like hypothyroidism), malabsorption neuropathies (like vit. B12 deficiency), infectious neuropathies (like Lyme disease), inflammatory neuropathies (like SLE) and substance abuse neuropathies (like alcoholism).

    Neuropathies from the spine would originate from the cervical spine as you have hand involvement. Compression in the thoracic and lumbar spine would not cause upper extremity symptoms.

    I am curious about your physical examination as if you had long tract signs (hyperreflexia and Hoffman’s signs among others), that would lead me to look at the cervical spine.

    Look under peripheral neuropathy on the website to understand what could be occurring. Maybe consider a neurologist (not a neurosurgeon) and get a consult with an EMG/NCV test to help with your current diagnosis. Maybe a new MRI of the cervical spine should be considered.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Vjenkins
    Member
    Post count: 10

    Thank Dr. Corenman for responding. My neurosurgeon took an X-ray of my neck that day and he did not see anything. He said it looked like my bones were healing well. You mentioned another MRI of my cervical spine, I will ask him to do this.

    I had recently had my blood checked for GHP and iron, no issues there except low vit D, which I’m taking. I do not think they checked my B12 only my B6 if I recall correctly, not did my magnesium get checked.

    I’m not sure what the reference acronyms are but will look up. Also, the exam was very minimal, he only very slightly rubbed the side of my foot, that is all.

    I will look into seeing a neurologist as well. My neurosurgeon really didn’t say or do much, just ordered the MRI. It would be great to figure this out.

    If you have any other thoughts please post, thank you for your advice.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Unfortunately, your examination was not enough to reveal potential diagnoses. A neurologist consultation and an MRI of the cervical spine might yield valuable information.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Vjenkins
    Member
    Post count: 10

    Thanks again for responding and so quickly. I’m going to see about scheduling an EMG and NCV. I’ve been reading a bit about peripheral neuropathy and distal neuropathy. The distal neuropathy, as you had mentioned sounds like what I have. The question is, from what and how to treat? My neurosurgeon hasn’t read the results or contacted me yet, I will definitely mention these issues/concerns and request the above mentioned tests.

    What did you think of my MRI results, could you please comment on that?
    I’m curious to know what you think of the results.

    As always, thanks for your time.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Peripheral neuropathy can be caused by many identifiable processes like diabetes but many times, the process that causes this disorder cannot be identified. Probably genetics will eventually be identified as a significant cause.

    The process to treat peripheral neuropathy is to identify any modifiable processes that can cause this disease (diabetes, Lyme disease, hypothyroidism, etc…) and to treat the symptoms that are disagreeable (pain and severe pins and needles). The use of medications (see membrane stabilizers under medications on this website) can be quite helpful for some patients.

    Your MRI of the thoracic spine and lumbar spine demonstrates mild to moderate degenerative changes without any specific compression to the cord or nerves. The caveat is that I am looking at your MRI through someone else’s eyes which always makes me nervous.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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