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  • ReneeA
    Member
    Post count: 4

    Hello everyone, I am new to this forum.. I need guidance. I am a 43 yr old women. 7 years ago had a stiff neck..went to chiropractor who dx me with muscle spasm and MRI that showed cervical lordosis otherwise impeccable MRI. April 12 started jogging to lose weight, developed stiff neck. Went to chiropractor who Did X-rays and gave me first adjustment same day. Next day went back for 2 nd adj and X-ray results. Was explained I was having muscle spasms and arthritic area. He proceeded with cervical adjustment . Instantly after getting off table I felt like a knife was in my shoulder blade area. Took Motrin and went to bed. Next morning upon weakening walked downstairs and felt my foot wasn’t touching stair. Heavy feeling in legs. Dog got out and ran to get her and legs wouldn’t work in sync. Called chiro told him and was said ” nothing I did, neck doesn’t control legs.” So I called md.. Ordered me in ASAP, performed MRI and mra. MRI showed c5c6 severe cord compression, herniated disk among canal stenosis and bulging disks below c2 to t1… Forminal narrowing and lots of other crazy stuff.. Told immediate surgery on c5c6. Acdf ASAP. Post acdf now pitosis , emg shows c5 radiculopathy. Pain in forearm ,can’t lift or hold arm in “phone” position without hurting once I real ease phone.. shoulders two mths post surgery! Hard to lift with right arm. Neck rotation limited and pain daily. MRI post 10mths acdf says flatten cord, spinal stenosis and forminal narrowing improved now mild. Bulging disks still present. MRI says more than I’m saying now. Guess my question is what does flattened cord mean now? And c5 chronic radiculopathy now according to emg. Feel like 80 yr old now. Help me understand my future and what to expect. Can I get worse.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8611

    You had a disc herniation after a chiropractic adjustment which is rare but does happen. This herniation unfortunately compressed the spinal cord at C5-6 which explains your leg symptoms. The emergency ADCF surgery was necessary to prevent further damage to your cord. Ptosis (drooping eyelid) after an ACDF indicates injury to the sympathetic plexus (Horner’s syndrome) which runs along the outside of the cervical spine and is rarely damaged by the surgery itself.

    C5 nerve root dysfunction is typically related to foraminal stenosis at the C4-5 level. Flattening of the cord indicates that there is cervical stenosis also present at that level. If there is cord compression, there is danger of cord injury. If there is enough foraminal stenosis present to cause weakness of the C5 muscle group (deltoid), surgery may be the best way to control both these problems.

    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.
    ReneeA
    Member
    Post count: 4

    Thank you for your comments. I am still not clear on this. This is what my pre op MRI says vs Post op. the surgery was in May 2012. Btw had a MRI of cervical spine that said unremarkable study.
    2012:
    C2-c3 is unremarkable
    C3-c4 and c4-c5 posterior endplate ringing, and mild central disc bulging, producing mild canal stenoisis new from previous
    C5-c6 bilateral uncovertebral arthropathy, posterior endplate spurring, diffuse disc bulging, more prominent along both paracentral regions with a superimposed small left paracentral disc herniation and ligamentum flavum hypertrophy producing sever canal stenosis with compression of the cord. Moderately severe right and moderate left neural forminal narrowing at this level.
    C6-c7 small central disc bulge and ligamentum flavum hypertrophy producing mild to moderate canal stenosis and mild bilateral neural forminal narrowing.
    C7-t1 bilateral uncovertebral joint arthropathy ligamentum flavum hypertrophy and mild bilateral facet arthropathy producing mild to moderate neural forminal narrowing.

    Post op
    C2-c3 unremarkable
    C3-c4 and c4-c5 posterior endplate ridging and mild focal central disc buldging producing mild canal stenosis unchanged from previous.
    C5-c6 bilateral uncovertebral joint arthropathy and mild broad based posterior endplate osteophyte formation producing decreased canal stenosis now mild with mild flattening of the cervical cord and interval resolution of previously visualized bilateral neural forminal narrowing
    C6-c7 small sent real right paracentral broad based disc bulge slightly decreased in size from previous and ligamentum flavum hypertrophy producing canal stenosis decreased from previous now mild and no significant neural forminal narrowing
    C7-t1 bilateral uncovertebral joint arthropathy ligamentum flavum hypertrophy and bilateral facet arthropathy producing mild to moderate right and mild left neural forminal narrowing unchanged

    Basically these words are confusing. Is this arthritis and based on MRI in 2004 what the heck happened. I should explain that I went to the chiropractor for a stiff neck. I have straightening of cervical area. Guess I want to know why all this? I do know that the following day after second adjustment I had left leg weakness and stabbing pain near shoulder blade. Now I have right forearm pain. Emg said c5 however doctor thought is would have showed c6. I have neck , shoulder and now elbow to hand pain. Will I get worse? Why stenosis? And should I see a spinal neurosurgeon. I was active person who enjoys skiing, jogging. Now I’m scared I will do something to my cord? Please help me understand more of the jargon. Thank you so much

    Donald Corenman, MD, DC
    Moderator
    Post count: 8611

    I cannot comment on the changes from 2004 to current as with all radiological reports, we are looking at them through the eyes of the radiologist and every report has an interpretation that varies. There could have been significant degenerative changes on the MRI of 2004 that were not identified. As a good example, for the two MRIs that you list the results, there is no comment on foraminal stenosis of C4-5, either before or after surgery.

    In the first report “C3-c4 and c4-c5 posterior endplate ringing, and mild central disc bulging, producing mild canal stenosis new from previous”. There is no comment on any foraminal narrowing. In the second report, the same problem is noted “C3-c4 and c4-c5 posterior endplate ridging and mild focal central disc buldging producing mild canal stenosis unchanged from previous”. Again, no comment regarding foraminal stenosis.

    Interesting enough that the radiologist does comment on foraminal stenosis at C6-7 on each report.

    The EMG is helpful only for motor weakness and will not be positive in the face of only pain and sensation loss as the pain nerves are too small (C fibers) to be picked up by an EMG. The best way to determine pain generation is to use selective nerve root blocks (SNRB-see website) to determine what is causing the arm pain.

    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.
    ReneeA
    Member
    Post count: 4

    Thank you for taking the time to reply. I guess I am wondering what long term effects this can have on me. Is cord flattening anything to be concerned about? Is all these cervical issues of underlying arthritis? I know c5c6 was result of adjustment. Immediate pain and leg weakness, and feeling loss the next day. Brain and leg not in sync. Now that is fixed, do I need to worry about cord in future?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8611

    Cord flattening or central cervical stenosis can be concerning depending upon your activity involvement and the severity of the narrowing. The central cervical canal changes in volume with flexion and extension (bending your head forward and back). A forced extension can significantly narrow the canal and “pinch” the cord causing something called central cord syndrome (see website).

    If you involve yourself in sports that have a risk of a face plant at speed (snow or water skiing, biking-especially mtn biking, horseback riding and others), you have an increased risk of this injury. If you are more sedentary, the risk is less. Also, as I discussed before, the MRI interpretation is colored by the radiologist’s bias. One radiologist’s “minimal’ might be the next one’s “moderate”. These is less risk if the CSF (cerebral spinal fluid) surrounds the cord vs. “flattens” the cord on one side.

    Unfortunately, I cannot give you the risks in terms of percentages. I know how many individuals develop central cord syndrome but do not know the denominator. That is, how many individuals have this disorder but never develop central cord syndrome. Your risk might be 1% or 10% (also depending upon your activity level).

    Yes, all these issues can be thought of as “arthritis” but that is a bad term for this disorder. It really is called degenerative disc disease and is quite common in most everyone.

    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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