[Queen V]

#6779

A continuation of my initial post: Neck and Back — Please Help me Understand my MRIs

My internist (at a large teaching hospital) referred me to a neuromuscular physician specifically to look at my MRIs in an attempt to find out why I have chronic neck and lower back pain, involuntary muscle jerks and fasciculations. I have no idea why he chose the neuromuscular clinic, but thankfully, she found no evidence of neuromuscular disease.

She forgot I had MRIs to look at so she only viewed my cervical spine, not my lumbar. She brought up both saggital and axial views side-by-side. She clicked on the saggital image and went down each level of the vertebra while looking at the axial view on the right side of the screen. She did clarify that I have severe DDD with numerous osteophytes at many levels, but most importantly she clarified I have spinal cord compression/cervical stenosis. She showed me the saggital view with osteophytes (I don’t know what else?) pushing in on both sides? of the spinal cord (I don’t remember what level). The axial view had very little spinal fluid at that level. It looked frightening to me and I have no medical background. She said, “no wonder you’re in severe pain.” She said she wasn’t a neurosurgeon, but it didn’t look good.

She forgot to pass the MRI information on to my internist (she gave her assessment purely from a neuromuscular disease standpoint) so once again, my physician has no firsthand knowledge of the stenosis. Gosh darnit! At any rate, my internist took me at my word and referred me on to orthopedics. It shouldn’t have taken nine more years to get to this point.

Question: what role will orthopedics most likely play in my current situation? What is the typical “pecking order?”

In my initial post to you, the MRIs from way back in 2004 were ordered by an orthopedic doctor. The orthopedist’s Impression then was Multilevel cervical spondylosis. He stated, “It looks like the cervical spine is visualized and there is contrast for an arterial study. In looking at the study, I think there is cervical cord impingement with the right signal in the cord itself suggestive of myelopathy from cord impingement.”

Per the orthopedist’s request I personally handed the MRIs and his assessment off to a neurologist and he lost everything. This just feels unreal. . . .

Another question: How much more helpful is it to use contrast with an MRI? Does contrast help in visualizing pertinent structures? What determines whether or not to use contrast with an MRI? I guess I don’t understand why it wasn’t used in my most recent MRI — the radiologist’s notes seem as clear as mud or rather wishy-washy. My 2004 MRI with contrast seems very straightforward.

In reading your website, I most definitely have classic signs of myelopathy.

The involuntary muscle jerks and fasciculations: could they be caused by my neuropathy? By hypoxia? No one seems to know and I’m tired of being referred from department to dept. I think I need to tell them to stop searching.

One last bit of information and probably the reason for my lengthy posts: my Father had a fall on the ice in 1992. He had several cervical bone spurs and the trauma from the fall + bone spurs caused central cord syndrome. His deficits were immediate whereas mine have accumulated through the years. Many of our symptoms are very much alike.

I sincerely apologize for droning on and on. I’m weary of being “medically complex” and I guess I need someone very wise to lend an ear.

[Donald Corenman, MD, DC]

#6784

Please try and keep same subject threads together for continuity of information.

If you have cervical stenosis with myelopathy as you indicate, you are most likely a candidate for surgery (see website for details). If you are in the orthopaedic department, there should be a competent spine surgeon who can diagnose your disorder and perform appropriate surgery.

Involuntary faciculations can be from the myelopathy disorder.

Contrast in MRIs is only needed for special situations and it appears in your case, it is most likely not needed.

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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