DRAGONMemberAugust 3, 2012 at 4:17 amPost count: 14
Dear Dr Corenman
I have been known to have cervical spondylosis since 2003. Have had 3 MRI’s and my latest shows ‘early flattening’ of the spinal cord at the affected level with subtle signal change
I was examined in the briefest fashion sat in the chair by the Consultant, a quick tap with the reflex hammer a little sensation testing and that was it. But for a few years I have very brisk reflex in my left leg but not in my right, and in recent times
I have noted my left leg at the hip seems sometimes toi ‘give’ as though the muscle temporarily forgets to hold me up. It ius entirely unpredictable and sporadic and tends not to happen when moving briskly. Aside of this I get sporadic tingling/. numbness in the hands and a snesation of being off balance, plus other issues, for example poor night vision, and difficulty adjusting to a dim environment when entering, and note that in the mornings my pupils stay like pinpricks for a long time even coming back into a semi dark room doesn’t have much or any effect, as well as gettinbg frequent feelings of nausea and fatigue
At times, I have to wonder if I could even have something like MS
but I guess the MRI (albeit of the C spine ) might show evidence pointing to that if it were there
What the GP says is that the problems (C6/C7 ) (also have spondylosis at C5/C6 and some compromise to the nerve roots would not be respo0nsible for the very brisk reflexes. He and Consultants have not shown any interest in that, they say ‘tone’; is normal and when tone is normal brisk reflex doesnt matter, I read however that a large difference between reflexes on each side is pathological They are brisk both sides but probably on the left is twice as brisk
I also think that where signal change is noted at the level of the theca being indented and early flattening of the cord then that is what I understand to be mylopathy and I can expect some impairment of function perhaps ?
I feel my glute muscles are weaker too but they say the C spine wouldnt be responsible for this and they say my lumbar MRI was fine (haven’t had the thoracic spine scanned though
Sometimnes a foot will scuff on the street surface and I almost stumble and my left foot (the side with the much brisker reflex ) will seem to almost slap down most notable at alow pace
If I was to send you my C spine MRI would you look at it and tell me what you think re signal and flattening ? I can email stills from it but that wouldn’t be quite as effective
Anyway I don;t know what you make of thes e points and queries.
AndrewDRAGONMemberAugust 3, 2012 at 2:31 pmPost count: 14
just to be clear it doesnt say signal change, it says subtle increased signal’ sorry for the slight errorDonald Corenman, MD, DCModeratorAugust 6, 2012 at 10:47 pmPost count: 8465
Spinal canal narrowing with signal change in the cord is indicative of the beginnings of myelopathy. This causes dysfunction of the spinal cord and is associated with multiple signs and symptoms. Signs are findings on physical examination such as increased reflexes and imbalance with testing. Symptoms of course are what you would complain of. See the section regarding myelopathy on the website for a full explanation of these symptoms.
Not only is myelopathy a concern but acute injury to the cord is also possible. The spinal canal changes in diameter with flexion and extension. Extension or bending the neck backwards narrows the canal even further. This action can cause pinching of the cord and a resultant spine cord injury called a central cord syndrome. The potential for this injury increases with patients involved in activity that can cause falls onto the head. Biking, water and snow skiing, horseback riding among other activities fall into this category.
Normally on physical examination, the reflexes on both sides will be increased with the presence of myelopathy. There are rare presentations of injury to the cord that are only one-sided that can caused asymmetric hyper-reflexia. See Brown-Sequard syndrome of the website to explain this phenomenon.
Some of your symptoms could originate from the lumbar spine.
If you have developed the beginnings of myelopathy, surgery is generally recommended.
Dr. CorenmanDRAGONMemberAugust 7, 2012 at 4:17 amPost count: 14
Thank you very much
I have also sent a brief message by the form including a link to 3 of my MRI images just to clarify if I am seeing the ‘increased signal’
I did watch your helpful video about reading the scans
Thank youDonald Corenman, MD, DCModeratorAugust 7, 2012 at 8:58 pmPost count: 8465
The images indicate that you have an old injury or severe degenerative disc at C6-7. This creates significant angulation at this level. The good news is that the spinal canal is still capacious in spite of this deformity. There might be some evidence of cord signal changes on one image but this has to be compared to the axial images of the same level to confirm this finding.
Even if there is cord signal change (and I am not sure of this), there is no evidence that the current anatomy of the cervical spine caused this problem. The spinal canal is large and there is no evidence of instability.
Dr. CorenmanDRAGONMemberAugust 7, 2012 at 9:10 pmPost count: 14
Thank you for looking at the images I guess the thing is for me to be sensible in my activities and posture, and vigilant to any possible changes. I’m glad the spinal canal has plenty of space
I can’t recall any specific injury.
But I presume that as a degenerative condition, at some stage in the future this may produce some problems so all I can do is take as much care as possible and keep my fingers crossed, as well as persuade my primary care doc to schedule a fresh scan every coiuple of years or so
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