Donald Corenman, MD, DCModeratorSeptember 14, 2014 at 4:41 amPost count: 8508
The radiologist states “Intact cervical fusion, no instability”. I will hope this means solid fusion but that statement does not comment on solid fusion.
“Numbness, tingling and pain in my left anterior neck and arm” could be from any level from C4-5 to C7-T1. Could you be more specific regarding where this tingling radiates to and when it occurs in regard to neck position (bending forward vs backwards)?
Where exactly is your pain?
Dr. CorenmanleosgirlMemberSeptember 14, 2014 at 9:23 amPost count: 4
The pain, numbness and tingling is in the left neck/shoulder region. It starts around just below my jaw area and goes to the shoulder, about to the top portion of my arm (about 1/3 of the way down). The pain symptoms are intermittent and the pain is of a shooting type. The pain seems to occur more when turning head to the left or bending head back. The nurse said my knee reflexes were “brisk”.
I have not found anything in the reports to state “solid fusion”. Here is the findings in the X-Ray report:
The cervical vertebral bodies are normally aligned, except for minimal retrolisthesis of C3 on C4, no fractures are identified. There is a metallic plate with screws anteriorly from C4- C7, and the disc spaces are fused. No prevertebral soft tissue swelling. There is moderate disc space narrowing at C3-4 which is new from previous exam with small posterior osteophytes. No instability with flexion or extension.
Impression: Intact cervical fusion. No instability. Degenerative disc space narrowing at c3-4.
The MRI findings: Patient has undergone anterior cervical discectomy and fusion at C4-5 and C5-6. Vertebral bodies are of normal height and alignment. No cord lesions identified. Visualized structures within the posterior fossa and brainstem appear unremarkable. Spondylosis is present in the upper cervical spine with degenerative changes at C2-3, 3-4, 4-5, and 5-6. No areas of contrast enhancement are identified. On review of the axial images: At C2-3 there is no significant spinal stenosis or foraminal narrowing. There is a small broad-based posterior disc bulge.
At C3-4 there is a small broad-based posterior spondolytic disc bulge. No significant spinal stenosis. There is mild right and moderate left foraminal narrowing.
At C4-5 mild facet hypertrophy is present without spinal stenosis or foraminal narrowing.
At C5-6 there is mild bilateral facet hypertrophy. There is mild left neural foraminal narrowing. No significant right foraminal narrowing or spinal stenosis.
At C6-7 o spinal stenosis or foraminal narrowing is present
C7-T1 appears unremarkable.
T1-2 appears unremarkable.
Based on these reports, what do you think should happen in my case? My primary provider has prescribed Lyrica and Celebrex until I can be seen by the Neurosurgeon in mid November (soonest available appointment). These symptoms affect everything form work to driving and even sleeping.
I appreciate any input you can provide.Donald Corenman, MD, DCModeratorSeptember 14, 2014 at 10:52 amPost count: 8508
The dermatome pattern for your symptoms is consistent with the C4 dermatome. The symptoms become worse with “turning head to the left or bending head back”. This is also consistent with foraminal stenosis (see website).
You do have a solid fusion of C4-7 (“the disc spaces are fused”). It would be unlikely that these levels would be causing your symptoms as they don’t move.
The C3-4 level is now degenerating (“There is moderate disc space narrowing at C3-4 which is new from previous exam with small posterior osteophytes”). There is now foramina narrowing based upon the MRI; (“There is mild right and moderate left foraminal narrowing”).
If the physical examination confirms this nerve involvement, I would consider a SNRB (selective nerve root block) of C4. This will diagnose this level (see pain diary) and potentially give longer term relief.
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