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  • westie California
    Participant
    Post count: 138

    Hello Dr,

    I had a head trauma 10 years ago fell off ladder hitting back of head (12ft). Head imaging (MRA, MRI, CAT Scan)all negative. IAC negative.

    MRI- C4/5 Disc Herniation deforming thecal sac with bilateral neural foraminal narrowing, increased conspicuity on extension view and decreased conspicuity on flexion view

    C3/4, C5/C6 and C6/7 Disc bulges with C3/4 right neural foraminal narrowing

    C2/3 Bilateral neural foraminal narrowing

    Cervical spine straightening

    T2/3, T3/4,T7/8 and T8/9 Disc herniations deforming thecal sac
    T4/5,T5/6 and T6/7 Disc bulges

    Surgery:

    ACDF with instrumentation C5, C6 OCT 2012

    ACDF with instrumentation C3,C4, C7 Aug 2013

    Laminectomy C3-C7 with bilateral instrumentation Aug 2013

    I am still having headaches, dizziness, left arm pain, lack of range of motion, spams and motion intolerance. I have received nsaids, muscle relaxants, physical therapy, trigger points with no long reliefs. The headaches radiates on one side only. My neurologist ordered an MRI and came back with the following:

    1.straightening of the normal lordosis

    2.C3 productive changes of the posterior elements mildly impinging the posterior aspect of the spinal cord

    3.C3-C4 mild productive changes of the joints of Luschka and facet joint degenerative changes causing mild left neural foraminal narrowing

    4. C4-C5 mild productive changes of the joints of Luschka especially on the right

    5. C6-C7 mild productive changes of the left facet joint causing mild left neural foraminal narrowing

    6. C7-T1 productive changes of the joints of Luschka together with facet joint degenerative changes causing mild left neural foraminal narrowing

    My question is what are my options? Thannks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Well-falling 12 feet and impacting the back of your head without a skull fracture or brain injury is lucky in itself.

    I am confused. You had initially undergone an ACDF at C5-6 and then C3-4 but you reported a disc herniation at C4-5 “deforming thecal sac with bilateral neural foraminal narrowing”. Why were the initial surgeries above and below the level of C4-5 where you had a herniation?

    You underwent a laminectomy with posterior fusion at C3-7 after the other two surgeries. Why? Was there central stenosis and cord compression?

    Your lack of range of motion develops from two sources. First obviously, you have a fusion of C3-7 which will reduce motion.

    Second, I suspect is degenerative facet disease at C2-3 and possibly higher (“C3 productive changes of the posterior elements mildly impinging the posterior aspect of the spinal cord”). I will assume that “productive changes” are bone spurs and bone spurs are indicative of facet degeneration.

    Facet degeneration will reduce range of motion also. Careful visualization of the occiput-C1 and C1-2 facets would also be important to look for degenerative changes.

    As far as the left arm pain, you have some residual compression of the left C7 and C8 nerves but this is “mild” and with a fusion to C7, the C7 nerve should not be involved. However, the C7-T1 level still moves and nerve pain can be generated from that level.

    A selective nerve root block of an individual nerve (see website) will help identify the pain generator. It is a matter of understanding why this nerve is still sensitive to help ameliorate this matter.

    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.
    westie California
    Participant
    Post count: 138

    Thanks could you tell from MRI what is causing dizziness and headaches? My headaches are mostly in back of head on right side (occipital). The left bicep pain comes and goes and worsens if I sit or stand for long period of time.

    What are my treatment options if pt and medications don’t work? Thank you very much Dr. Corenman! Have a great night.

    Ashley

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Headaches have many sources from post-concussive syndrome (hitting your head) to facet arthritis of the upper cervical spine. I cannot begin to tell you the headache source with the limited information available.

    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.
    westie California
    Participant
    Post count: 138

    Last questions Dr and thanks for your time.

    What can be done to Luschka and facet joints neural foraminal narrowings and is C3 impinging spinal cord a concern? I appreciate all your help,

    Ashley

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Anytime the spinal cord does not have adequate room, this is a concern. The vertebral segments are mobile and extension (bending the head backwards) will narrow the spinal canal. A forced extension (impact on the front of the head) can pinch the spinal cord and cause an injury (central cord syndrome-see website).

    Foraminal narrowing is not as significant but can also cause radiculopathy (dysfunction of the nerve root). This includes pain, numbness, paresthesias (pins and needles) as well as possible weakness if the nerve root supplies major muscles. The C2-3 level does not supply any major muscles but does turn into the lesser auricular nerve which winds around the ear. Compression of this nerve can cause headaches in this region.

    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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