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  • backtolife
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    Post count: 10

    I just had a cervical lateral flexion extension x-ray. I kept my neck very straight and bent only my chin down for this for flexion and kept my neck very straight and looked straight up for extension. Was this the right way to check for instability? HAd it done at chiro office. Neuro ordered it.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8379

    Normal technique for flexion/extension cervical X-rays is to literally bend forward from the head as far as possible keeping the shoulders in the neutral position. It is the exact reverse for the extension view again keeping the shoulders in the same position but extending the head backwards as far as possible (but creating no significant 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.
    backtolife
    Participant
    Post count: 10

    Thank you very much for your response. I did not do them like that at all–could it make a difference in checking for instability which is what, as I understand, my neuro is checking for? I have a “retrolisthesis of C5 on C6.” I have read about an MRI made by FONAR that can allow for an MRI of the neck in flexion and extension. Is that a good study to measure for instability or is the flexion and extension x-ray better? I had a myelogram with a CT scan that shows nerve root compression at C5-6, 3 injections without a great deal of success (continued arm weakness, continued neck pain that can increase astronomically with movement.). Thank you for any response in advance.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8379

    The technique used could theoretically make a difference in looking for instability but instability is typically somewhat obvious by looking at even a standard lateral X-ray.

    The FONAR MRI is something that I am not a big fan of. The images are not great and all the information can be obtained by the FONAR MRI can also be obtained by a good set of X-rays and a good MRI.

    Please review the section under “Conditions”- “How to describe symptoms” and let me know what your history is. That way, I can give you an idea of what origin your pain could possibly be from.

    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.
    backtolife
    Participant
    Post count: 10

    Thank you Dr. Corenman. I have neck pain/tenderness in my “left trap near the left scapula border” (from dr. note) and left upper arm weakness. I also turn my upper body to the left to look left as my range of motion is “restricted” or less. I am left handed. To raise my left arm straight out in front of me (from hip to shoulder), my arm is weak, slow to respond, feels heavy. If I try to shrug my left shoulder, my muscles that pull the top of my shoulder up feel very weak and it does not feel good in my lower to mid neck, to the left of my cervical spine. If I try to “make a muscle” with my left arm, I feel like I don’t have the strength and I can touch that bicep, feel and see that it’s size is less than what it used to be–I can see and feel that it is smaller and spongy, not near as solid as it used to be. I presently have pain to touch/tenderness in my neck to the left of the mid to lower cervical spine (if one is look at the back, it is located mostly in the backward “L” shaped area). The pain had been shooting, burning a lot (just at anytime at all but not constant) and would shoot out across the top back of my left shoulder. If I would reach a certain way with my left arm, I would get hit with an incredible burning that would drop me to my knees. My upper left arm would go weak. The shooting, burning is not as frequent but I did have 3 ESI’s, one @ C7-T1 in 2/12, 1 at C5-6 in 3/12 and 1 at C5-6 at the beginning of this month. I feel that they helped to reduce the frequency of the shooting, burning; however, I do still have shooting burning in the same areas, just not as frequent and my left arm remains weak. The arm weakness is 70%, neck 30%.

    Since this all did not just happen recently, let me give you the history as to the evolution of the symptoms. I was lifting a lot of weight a couple of years ago, 2010. Saw stars (white light) when I was lifting, but nothing popped, cracked, etc., didn’t think much of it, finished was I was doing and I went to lay down. I could not get comfortable due to discomfort. Took ibuprofen, eventually went to sleep. Got up, felt “crooked,” went to work out, got on treadmill, felt like a “bobblehead,” couldn’t stand discomfort, had gotten worse, got off treadmill. More ibuprofen that night. Got up next day, had terrible burning pain when I turned my head to right, my left upper arm was weak and I could barely turn my head to the left. Burning got worse. Family dr. gave me steroids, muscle relaxers, which helped but I continued with pain/discomfort. Couple weeks later, when lifting an object, got burning & arm weakness again. Got MRI, edema @ C5-6 with some degeneration there. Went to PT which helped but still felt arm was a little weak and continued with intermittent shooting burning to left of mid to low cervical spine and across top of back left shoulder. Would take Alleve and/or Ibuprofen. In 2011, got an INCAPACITATING flare in burning when I went to plug in a machine with my left arm (was reaching to the right, across my face). This flare had me on ice for a couple of days with steroids, muscle relaxers. Went back to Physical Therapy. Symptoms were reduced but never left. Out of physical therapy for less than 1 month, incapacitating burning flare again. Incapacitating burning flares got more frequent (mostly with moving my arms, neck–I went to the ER one time it was so bad), arm got weaker and stayed real weak, so I went to pain mgmt. Got medicine for nerve pain, take anti-inflammatories. More recently, got injections (didn’t want to do those at first because I don’t like needles). Left arm still weak maybe a TINY bit of improvement. Go to see my neuro next month. Any insight you could offer would be appreciated. I know this is very long but I wanted to give you the history of how it started, its evolution and where I presently am. Overall, the MAJOR flares in burning pain increased, particularly in the last 8 – 10 months, and my arm is more consistently, profoundly weaker than my other arm. This whole issue has become very stressful, painful and I have great concern about my arm. Any information you could offer would be greatly appreciated.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8379

    To distill your history down, you have left sided neck pain that radiates into your trapezius muscle region. This has been present for the last two years with a significant flair-up last year. You note weakness of your biceps muscle and possibly your deltoid muscle; “To raise my left arm straight out in front of me (from hip to shoulder), my arm is weak, slow to respond, feels heavy”.

    Your pain distribution is 70% left arm and 30% left neck (if that goes along with the weakness ratio).

    You have had three epidurals with some relief but your pain and weakness are still significant. You have had an MRI with results that note; “Got MRI, edema @ C5-6 with some degeneration there”. I am not sure what that means.

    Your report most likely indicates that you have a C6 radiculopathy but the C5 nerve could also be involved if you have deltoid weakness (see website under cervical herniated disc). I am sure that your MRI notes foraminal compression of the C5-6 level on the left based upon your symptoms.

    You have had this pain too long not to have seen a spine surgeon. Please get a consult as soon as possible. I think you will be happy with the results.

    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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