[GSEVEN]

#11184

Hello Dr. Corenman,

thank you for taking the time to answer my questions. To give you a brief history of my situation is as follows.

2012 Symptoms: Right side neck & shoulder pain with weak right arm bicep strength.

05/2012 MRI
Broad-based disc bulge with small central extrusion extending caudal to this level creating mild central canal narrowing. Mild left greater than right-sided neural foraminal narrowing.

Recommendation: ACDF 2-level,C4-5-6,autograft with plating.

Decision: I was told “it couldn’t get worse”, so I opted to wait. Continued to presume aggressive activities that made things worse.

2014 Symptoms: Same as 2012 but including sever muscle spasms all over body in random locations.

MRI 03/2014
CERVICAL DISC LEVELS:
C2-C3: 2 mm focal central protrusion slightly attenuating the ventral thecal sac without contacting the
cord. No central canal stenosis. No foraminal stenosis.
C3-C4: 2 mm focal central protrusion attenuating the ventral thecal sac, contacting but not deforming
the cord. No central canal stenosis. No facet abnormality or foraminal stenosis.
C4-C5: 2 mm spondylotic disc bulge and osteophytic ridge with mild loss of disc height. Mild
redundancy/hypertrophy of the ligamentum flavum. Mild central canal stenosis. Bilateral
uncovertebral and right facet hypertrophy. Moderate right and mild left foraminal stenosis.
C5-C6: 4 mm focal central protrusion superimposed on spondylotic disc bulge, osteophytic ridge and
mild redundancy/hypertrophy of the ligamentum flavum. Moderately severe central canal
stenosis. Moderate cord compression. Mildly increased cord signal. Moderate bilateral
uncovertebral hypertrophy with moderate bilateral foraminal stenosis.
C6-C7: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
C7-T1: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
CONCLUSION:
1. Large focal central disc protrusion at C5-C6 superimposed on spondylosis with moderate
cord compression and moderately severe central canal stenosis.
2. T2 hyperintensity in the compressed cord at C5-C6 suspicious for spondylotic myelopathy.
3. Small focal central protrusion at C3-C4 contacts the cord centrally but does not deform the
cord or cause central canal stenosis.
4. Mild acquired central canal stenosis at C4-C5.
5. Multilevel facet and uncovertebral arthrosis with multilevel foraminal stenosis, distribution and degree described above.

Different Doctor recommendation: C5-6 fusion with carbon cage and non plating. Synthetic graft to promote my own cell growth.

Conclusion: I was told by both doctors if I don’t have this operation I will lose function of my right arm and legs and could be walking with a cane or wheel chair in the near future.

Here is where my dilemma is Dr. Corenman. Since the 2ND MRI I have ceased prior aggressive physical activities that progressed between 2012-2014 and since my pain is now gone. I only feel some tightness between neck and shoulder in the “Spock vulcan nerve pince” area if I am completely inactive. Light physical activity actually makes it almost unnoticeable. My right arm bicep strength has returned to almost 90%. I am no showing any loss of motor skills or reflexes and have perfect balance.

I stuck between a rock and a hard place to make a decision on whether to have the surgery or wait. I told mylothopy doesn’t necessarily have have signs of pain and is a silent killer and is like a “ticking time bomb”. My concern is I have C5-6 done and 10 years later I will have to go again under the knife again because possible adjacent disc issues or I may have more pain due to the surgery itself. I don’t have hardly any pain now so its hard for me to justify going through with surgery.

Should a diagnosis and recommendation for surgery be based on MRI evidence alone? Any insight into my situation would be greatly appreciated.

Chris

[GSEVEN]

#11185

oh and sorry I forgot to mention my muscle spasms have decreased 90% as well. I still have light muscle spasms here and there but nowhere near how they were when aggressively physically active.

[Donald Corenman, MD, DC]

#11257

“C5-C6: 4 mm focal central protrusion superimposed on spondylotic disc bulge, osteophytic ridge and mild redundancy/hypertrophy of the ligamentum flavum. Moderately severe central canal stenosis. Moderate cord compression. Mildly increased cord signal. Moderate bilateral uncovertebral hypertrophy with moderate bilateral foraminal stenosis”. added to this is the comment “T2 hyper intensity in the compressed cord at C5-C6 suspicious for spondylotic myelopathy”.

You have relatively severe central narrowing of the spinal canal with a cord injury. In my opinion, you need a fusion surgery. It is motion associated with a very tight canal that makes this a dangerous condition. The rest of the spine is acceptable at this point based upon the radiological report.

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.

[GSEVEN]

#11275

Thank you Dr. Corenman for taking the time to review my MRI report. The fact that you take time out of your busy scedual to answer these questions shows a lot. Your a rarity. I’ve read a lot of your post and I trust your professional opinion.

Thank you!

[Donald Corenman, MD, DC]

#11329

Please let us know of your future care.

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.

[aikamchawla]

#11493

Hello Dr. Corenman,

Recently my father started having pain in his cervical area but after stretching a little, the pain got consumed. The pain started recurring more and more frequently and after consulting a orthopedics doctor it was identified as Muscle Spasm. After almost 2-3 days the pain started to build in his arm too and he was having numbness in his left thumb. This time we got MRI done for the Cervical Spine. The results are as follows:

Spinal Curvature- There is loss of normal lordosis. Suggestive of para-spinal spasm.
Spine Allignment- Normal
Vertebral Signal Intensity-Normal
Vertebral Body Height-Normal
Endplate Signal Intensity-Normal

Disks:
C2-C3:Normal
C3-C4:Normal
C4-C5;small focal posterocentral disk protrusion indenting the thecal sac
C5-C6:left paracentral and foraminal disk osteophyte complex impinging on the left exit nerve root with inferior migration extending to the midbody of
C6 vertebra.

C6-C7:Normal
C7-T1:Normal

Lateral Recesses are all Normal.
Please guide me the best treatment to follow in this situation. Your guidance will be very helpful

Thanks

[Author]

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