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  • BellieKiss1
    Member
    Post count: 4

    I recently had an MRI due to severe pain in the front and back of my shoulder, in my biceps, elbows and tingling and numbness in my fingers. Can you please look at the findings and let me know if you believe there are any remaining options aside from surgery? I had a steroid injection about 3 weeks ago, and continue to have all of the same pain issues. (I sent an email not fully understanding the forum, so I hope that I am not causing you double work – sorry.) I am scheduled to meet with an Orthopedic Surgeon on the 19th of Nov. and just want to make sure that I have considered all options and consulted another Spine Surgeon.

    The findings of my MRI are: Sagittal scans demonstrate progressive disc space narrowing, uncinate hypertrophy and Modic type II endplate changes at C6-7 associated with a diffuse grade 1-2 bulging disc producing a mild spinal stenosis. There is interval appearance of diffuse grade 1 bulging disc and right lateral recess grade 2 disc protrusion at C4-5 without significant spinal stenosis. Remaining discs are normal in appearance for age. Mild multilevel facet disease is present. Loss or lordosis of the cervical spine is again appreciated.

    Spinal cord and bone marrow signal unremarkable. Alignment is otherwise normal. Visualized posterior fossa unremarkable. Oblique sagittal foraminal scans demonstrate u ncinate hypertrophy and facet disease producing moderate to sever right and moderate left foraminal stenoses at C6-7. A right lateral recess grade 2 disc protrusion is present at C4-5 without significant foraminal stenosis. Moderate facet disease is noted at T2-3 producing a moderate left T2-3 foraminal stenosis.

    BellieKiss1
    Member
    Post count: 4

    Hi Dr. Corenman. Thank you so much for your time. I thought that it might be helpful if I included the breakdown on the mri for the individual discs. Have a wonderful weekend, and thank you for your input and for providing this amazing forum! Warmly, Kellie

    Axial scans performed C2-T1:
    C2-3: Mild facet disease present. Disc unremarkable for age w/o stenosis.
    C3-4: Normal for age without stenosis.
    C4-5: Diffuse grade 1 bulging ddisc is associated with a right laateral recess grade 2 disc protrusion w/o significant stenosis.
    C5-6: A shallow right paracentral grade 1 disc protrusion is present without neural compromise or stenosis.
    C6-7: Diffuse grade 1 bulging disc and moderate uncinate hypertrophy produces a mile spinal and moderate severe bilateral foraminal stenoses wwith residual central AP canal diamter of 8.5mm.
    C7-T1: Normal for age w/o stenosis.

    IMPRESSION:
    1. Progressive degenerative disc and uncinate disease at C6-7 producing mild pspinal and moderate to severe bilateral foraminal stenoses as described.
    2. Interval appearance of diffuse grade 1-2 bulging disc and right lateral recess grade 2 disc protrusion at C4-5 w/o significant stenosis.
    3. Shallow right paracentral grade 1 disc protrusion at C5-6 w/o neural compromise or stenosis.
    4. Moderate facet disease at T2-3 producing foraminal stenosis as described.

    I have a few questions…I hope you don’t mind.

    1) I am experiencing loss of ‘strength’ in my right hand. It almost seems as if it just isn’t responding. If feels dull (no harsh pain). Is feels unresponsive and it scares me. I am accustomed to the pain, but this is a new thing. Is this something to be worried about prior to my appt. on the 19th.

    2) I don’t know if it is possible for this to be related to my neck problems – but over the last month or so, I have also experienced some pains in my legs; particularly the outside of my thighs. I notice it at night, when I am trying to sleep. Is there any way that this is associated? I have long term back injuries but haven’t suffered from that in over a year.

    Thank you again.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Your MRI notes significant neuroforaminal narrowing at C6-7. This is the exit zone for the nerve root of C7. Compression of this root will cause pain and numbness that radiates into the middle of the hand and weakness of arm and some hand muscles. Mild spinal stenosis or mild narrowing of the canal the spinal cord occupies should not cause cord dysfunction. The other levels will not cause spinal cord or nerve root problems.

    Since the main problem looks to be nerve root related, it most likely does not appear that you need to move up your appointment, The leg pain should not be related to your neck.

    Dr. Corenman

    BellieKiss1
    Member
    Post count: 4

    Dear Dr. Corenman,
    Thank you so much for the reply. Would you mind telling me what you feel is my best course of action based upon my MRI results. My Dr. Indicated that we need to take out discs on 4-5, 5-6 and put in spacers, fusion on both sides and installation of a plate. He will discuss this with me on the 19th. This information was conveyed in a call following his PAs reading of my results. Thank you again for your knowledge and assistance – and this amazing forum!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    I am confused by the surgeon’s recommendation. Your worst level in the cervical spine seems to be the C6-7 level by report. I am unclear as to why the surgeon suggests an ACDF of the C4-5 and C5-6 levels. Maybe the physical examination honed in on the levels above or the radiologist’s interpretation of the images is different than the surgeon’s interpretation.

    Did you undergo a complete physical examination with testing of all the upper extremity muscle groups? The biceps, triceps, deltoid, wrist and hand muscles as well as arm internal rotation (tennis forehand) and external rotation (tennis backhand) muscles? Was sensation tested as well as reflexes?

    When you say the surgeon wants to do perform fusion “on both sides”, do you mean both a front incision for the ACDF and an incision on the back of the neck too?

    Dr. Corenman

    BellieKiss1
    Member
    Post count: 4

    They performed all of the tests in office prior to referring me for my MRI. I am not really clear on why we didn’t address 6-7. I go in on the 19th for a comprehensive discussion about surgery suggestions. I agree – but I believe it is my lack of understanding. (I was on an online Skype class and was not at my best while he was conveying information). But I wrote down what I heard at the time. Can I Send you my actual MRI And ask what you would recommend i do based upon findings. I have lost significant strength in my arms, right side predominantly. I have horrible nerve pain and tingling and loss of strength. I don’t know about the fusion conversation….yikes! I had never thought of the front and back entry…..help. ;D. I sure appreciate your time and input.

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