SpinemanParticipantJuly 10, 2018 at 5:07 pmPost count: 2
Hello. This is my first time on this forum. I wanted to get the doctors take on my cervical spine issues. I am a 40 yr old male whose already had 3 lower back surgeries. Currently I am experiencing neck pain, both left & right but worse on my right. Along with this pain I am having wide spread shoulder pain. The right shoulder pain extends down my arm through my bicep, forearm, side of forearm and to my 2nd & 3rd fingers. The left side of my shoulder pain also extends to my bicep and forearm into my thumb, 2nd & 3rd fingers. I also have numbness and pins and needles on both hands. I’m feeling increased pain in my right bicep and shoulder when I turn a door knob and turn the steering wheel of my car. My last MRI of a few months back reveal the following:
C1-2 normal alignment. There is mild arthrosis. The cerebeller tonsils project up to, but not through the foramen magnum.
C2-3 No stenosis. The vertebral arteries are co dominant.
C3-4 right foraminal protrusion and inconvertible joint osteophyte change. Severe C4 foraminal stenosis. Mild flattening of the right anterolateral thecal sac without cord compression.
C4-5 right paracentral protrusion & endplate osteophyte flatten the right ventral cord. Uncovertabral joint osteophyte with severe right C5 foraminal stenosis.
C5-6 decreased T2 nuclear signal with small central protrusion. This mildly flattens the thecal sac. U covertabral joint osteophyte are more prominent on the left side and there is mild/moderate left C6 foraminal stenosis.
C6-7 ligament flavum hypotrophy abuts the dorsal cord without significant compression. There is mild decreased T2 nuclear signal and a mild disc bulge. Uncovertebral joint osteophyte mildly narrow the C7 neural foramen bilaterally.
C7-T1 no stenosis
After several failed treatments I was told that I would need an ACDF on C3-4, C4-5. Can you give some feedback? Do these issues tend to get worse over time? Thank you.Donald Corenman, MD, DCModeratorJuly 11, 2018 at 12:12 pmPost count: 6438
You have significant foraminal stenosis at C3-4 and C4-5 on the right (“C3-4 right foraminal protrusion and inconvertible joint osteophyte change. Severe C4 foraminal stenosis”. “severe right C5 foraminal stenosis”.) This would cause both C4 and C5 root compression with all the symptoms associated. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C4 and a C5 root compression looks like.
You do have some C6 root compression on the left (“left side and there is mild/moderate left C6 foraminal stenosis”) which might explain your left sided arm symptoms.
Your right sided arm pain that radiates into your middle fingers fits with a C7 nerve root but that is not what your MRI notes (the lowest significantly compressed right nerve root is C5 which does not radiate into your hand).
The next step in my practice is selective nerve root blocks, both for diagnosis and treatment. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!SpinemanParticipantJuly 11, 2018 at 12:27 pmPost count: 2
Thank you for your response. One quick question; if left untreated, does this have the tendency of getting worse?Donald Corenman, MD, DCModeratorJuly 11, 2018 at 1:47 pmPost count: 6438
Depends upon your response to nerve blocks and therapy. Many patients improve but there is a slight tendency for the bone spur formation to progress and cause more compression of the nerve over time.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!
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