Tagged: cervical spine
DRAGONMemberFebruary 19, 2012 at 11:17 pmPost count: 14
Dear Dr. Coleman
I have a longstanding cervical spondylosis, aged 48, problem first noted about 9 years ago. My latest MRI a few weeks ago showed C6/C7 disk dessication with loss of disk height and circumferential irregular osteophytosis. The circumferential disk bulge decreases the calibre of the exit foramen with possible bilateral C& root compromise. The bulge also indents the theca causing early flattening of the cord at this level with subtle increased cord signal at this level
The remainder of the c spine is normal except for the haemingioma within the C6 vertebral body, bone marrow otherwise returns normal signal
My symptoms are mainly sporadic numbness.tingling in hands, some stiffness in legs sporadically, a sense that legs are not as strong as previously, and a little dizziness at times, stiffness of neck, soreness and pain radiates to shoulders and into arms, though not all the time
My question is does the MRI suggest that my spinal cord is or is likely to become damaged, can mylopathy be evident without overt neurological signs ? I have only a brisk reflex at the left knee that is normal at the other side
I am worried about the term ‘early flattening’ of the cord and that if my function is left until it becomes a crisis, any surgery might not leave me as functional as if it was addressed earlier
Your advice about these terms and general questions much appreciated
AndrewDonald Corenman, MD, DCModeratorFebruary 19, 2012 at 11:39 pmPost count: 8507
You have symptoms of intermittent hand numbness and paresthesias, intermittent leg “stiffness” and some loss of strength and some symptoms in your neck (pain and stiffness). On physical examination, you have an increased deep tendon reflex of the left knee as your only long tract sign. Your MRI notes flattening of the cord with an increased signal at C6-7.
There are some findings that concern me. The degenerative disc at C6-7 can cause neck pain and stiffness as well as bilateral shoulder ache. Those symptoms by themselves are not too concerning. Flattening of the cord can be a significant sign but the signal change in the cord is the most worrisome finding.
Normally, signal change in the cord is from injury. The space available for the cord changes with neck positions. The spinal canal gains 20-30% in volume with flexion (bending the head forward) and narrows by the same with neck extension (bending the head backwards). If you have had a prior fall or head impact that caused forced extension, this could cause subtle cord injury. Even repeated extension without a fall can cause cord compression.
The symptoms of leg stiffness and lack of leg strength could also be from myelopathy. I think a consult with a good spine surgeon is called for. Try to avoid activities that put your neck at risk prior to this consultation (horseback riding, mountain biking, skiing, rock climbing).
Dr. CorenmanDRAGONMemberFebruary 19, 2012 at 11:53 pmPost count: 14
Hi Doctor Corennman
I saw a neurosurgeon last Sunday abouit it and he said he thought there was no major problem but he did say that ‘ your cord may be getting pinched some of the time with movement’ ‘signal change can be something, can be nothing but your neurological signs are normal’ he said
He didnt pick up the knee reflex issue, as he used the hammer on me whilst I sat next to him, fully clothed. It was my own doctor who established that, and the physio I saw almost 2 years ago also noticed that hyper reflex in my left knee
However, I can confirm my previous 2 MRI (2007 and 2009) did not show flattening or signal change and I have not suffered any accident inbetweeen times
The only thing that has certainly happened between the 2009 MRI and now is a tendency ion the last 18 months to sudden episodes of very high BP or tachycardia, cardio work up has eliminmated cardiac cauises. I’m womdering about CNS causes
The neuro service have discharged me and I fear that they have
abandoned me to my fate
Thank you so much for replyingDonald Corenman, MD, DCModeratorFebruary 20, 2012 at 1:07 amPost count: 8507
New symptoms of hypertension and tachycardia are most likely not related to your neck. Those symptoms can be related to pain but not to cord compression.
Did you inform the surgeon of numbness in the hands and legs as well as intermittent “heaviness or weakness of the legs”? These can be symptoms of myelopathy (see section on myelopathy on the website).
Another opinion by a good spine surgeon might be very helpful to you.
Dr. CorenmanDRAGONMemberFebruary 20, 2012 at 3:00 amPost count: 14
Thanks again for replying
I told him about those symptoms but he was satisfied that because he could not elicit neurological signs and in view of the minor level of cord flattening etc that he should discharge me.
I have to say however that he did not ask me to walk in front of him which I had anticipated would be part of assessment nor examine me on a couch or even touch my neck itself
I beleive that having seen the MRI he did not want to intervene surgically, that no doubt NHS resources and clinical priorities
probably favor more advanced disease, not that he said that. He said ‘I could remove that disk but you would not gain any advantage’
AndrewDonald Corenman, MD, DCModeratorFebruary 20, 2012 at 4:10 amPost count: 8507
I cannot confirm this comment but I would say that the NHS most likely has a much higher threshold for surgical indications due to the high demand on surgeon’s services. With cord signal changes, I believe that most spine surgeons in the USA would consider surgery but not all. Your experience regarding the time taken for physical examination is sad but not unusual. It even happens here with pay for service.
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