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  • riclach
    Participant
    Post count: 20

    Dear Dr. Corenman,

    thank you so much for giving your time to this wonderful site!!!
    I would like to ask your opinion of my cervical MRI which was done last week.
    I have uploaded the images on a Youtube slideshow but I don’t think I’m allowed to post the link here. So I sent it to you via the contact form.

    A little background –

    I’m a 48 year old female.
    Diagnosed with Ankylosing Spondylitis in 2010 but I’ve had pain since age 19. My spine is not fused. I have sacroiliac inflammation and enthesitis in many places of my body.
    I’ve had neck pain since 10 years. I also suffer from migraines.
    Five years ago, a cervical MRI showed bone spurs but no stenosis.
    For the past months, I’ve been having tingling and numbness down my right arm into my hand and fingers as well as electrical shooting pains down my right shoulder blade. I also have Carpal Tunnel.
    I’m right-handed but I feel I have more strength with my left side.

    Two weeks ago I had a Nerve Conduction Study and EMG that resulted in mild right median nerve entrapment across wrist/carpal tunnel and mild right C7 radiculopathy. Needle EMG demonstrated chronic denervation along with ongoing reinnervation. Physical examination demonstrated hyporeflexia of the right biceps/brachioradialis muscle stretch reflexes.

    The Cervical MRI I just had done reported the following –

    C1-C2 Mild degenerative changes present.

    C2-C3 No significant central canal or neural foramina stenosis

    C3-C4 Right greater than left uncovertebral hypertrophy resulting in mild right neural foramina stenosis.

    C4-C5 Diffuse disk bulge and bilateral uncovertebral hypertrophy. These result in mild bilateral neural foraminal stenosis. The ventral thecal sac is effaced and there is minimal cord contact. No cord edema or myelomalacia. No cord deformity.

    C5-C6 Bilateral uncovertebral hypertrophy in addition to a diffuse disk bulge. There is moderate bilateral neural foraminal stenosis and effacement of the ventral thecal sac with probable cord contact. No evidence of abnormal cord signal. No cord deformity.

    C6-C7 Bilateral uncovertebral hypertrophy resulting in moderate left and mild right neural foramina stenosis. There is minimal effacement of the ventral theca sac by a diffuse disk bulge without cord contact.

    C7-T1 No significant central canal or neural foramina stenosis.

    Impression: 1. Multilevel degenerative disk disease with disk bulges resulting in cord contact at C4-C5 and C5-C6. No significant cord deformity or abnormal cord signal intensity. 2. Low-to-intermediate grade multilevel neural foraminal stenoses are present bilaterally.

    Does cord contact mean some cord compression?
    Do I have stenoses with myelopathy?
    Finally, is this a progressive situation where, eventually, surgery will be needed?

    I will be doing an epidural injection and physical therapy. My doctor also gave me a referral to go talk to a spine neurosurgeon.

    THANK YOU!!!!!!

    Claudia

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Ankylosing spondylitis (AS) can cause spine pain but no arm or leg pain so we can rule that out as a cause of your “tingling and numbness down my right arm into my hand and fingers as well as electrical shooting pains down my right shoulder blade”. The cervical spine can degenerate regardless of the presence of AS and that appears to be the source of your symptoms.

    Carpel tunnel syndrome (CTS) can cause tingling and numbness (paresthesias) from the wrist into the hand and even up the arm somewhat. CTS does not cause shoulder symptoms. See the section on CTS here on the website to understand this disorder more completely.

    The C6 nerve exits between C5-6 and C7 exits between C6 and 7. Check the section “symptoms of cervical nerve injuries” to understand what type of symptoms each nerve can generate.

    “Moderate bilateral neural foraminal stenosis” at C5-6 and C6-7 more likely can be the source of your symptoms. An increase of the paresthesias in your arm with neck extension would be the typical findings with the origin from your neck.

    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.
    riclach
    Participant
    Post count: 20

    Thank you so much for your reply, Dr. Corenman.

    Does cervical cord contact usually lead to cord compression?

    Thank you!

    Claudia

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Cord contact does not always lead to cord compression. The entire canal normally has to be narrowed for cord compression.

    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.
    mial33
    Member
    Post count: 1

    Dr. Corenman,

    I don’t totally know what all this means but is there a chance that the issues found in this exam could cause migraines, lightheaded and numbness in just one part of a body? By that I mean just going numb from the wrist to the finger tips! If you could please explain this to me!
    Exam: CT cervical spine without contrast.

    Technique: Computed tomographic imaging of the cervical spine was performed without contrast.

    Findings:

    There is no evidence of acute fracture. There is straightening of the cervical lordotic curvature which may be positional or due to muscle spasm. The vertebral bodies are normally aligned. No facet joint dislocation is evident. Small endplate osteophytes
    are seen at several levels are seen at the C6-C7 level. Intervertebral disk spaces and vertebral body heights are grossly preserved. Cervical soft tissues show no abnormality. Visualized lung fields are clear other than probable minimal apical scarring.

    Impression:

    No cervical spine fracture or malalignment.

    Thank you for your time!

    Mia

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    The CT scan is not the best study to look for migrane or lightheadedness origins but if there are degenerative facets in the upper cervical spine, these might show up on this scan. There is no report of these findings.

    “Going numb from the wrist to the finger tips” sounds more like carpel tunnel syndrome (see website) than cervical origin.

    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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