[mocka300]

#35146

My primary (NP) called me and said the fusion looked good. I didn’t see your comments until after I spoke with her.I also thought it was interesting that there was no mention of the decompression. I sent a note to the NP asking her about it and she called the radiologist who then wrote an addendum to the report. See below. I am guessing the facet blocks and the nerve root blocks are still good diagnostic tests for me. I also wanted to share the data imaging review that the pain management doctor put together, from past MRI reports, when I was seeing him.

ADDENDUM TO ORIGINAL REPORT

MRI is superior to evaluate spinal canal and neuroforamina.

C2-C3: Tiny broad-based disc bulge. No significant bony spinal canal or neuroforaminal narrowing.
C3-C4: Tiny focal central disc bulge. No significant bony spinal canal or neuroforaminal narrowing.
C4-C5: Tiny focal central disc bulge. No significant bony spinal canal or neuroforaminal narrowing.
C5-C6: Evaluation is limited due to extensive streak artifact from orthopedic hardware. No significant bony neuroforaminal narrowing. Estimated mild bony spinal canal stenosis.
C6-C7: No significant bony spinal canal or neuroforaminal narrowing.
C7-T1: No significant bony spinal canal or neuroforaminal narrowing.

DATA/IMAGING REVIEW:
MRI lumbar spine 1/2/2020 report and film reviewed compared 2014 MRI–motion artifact. Back pain since September 2019. At L1 -2 there is minimal broad-based left paracentral disc protrusion. At L3-4 there is disc bulging with a broad-based left lateral disc protrusion producing mild left L3 and L4 nerve root impingement. There is a perineural cyst on the right. L4- 5 there is an annular tear on the left which is stable. L5- S1 there is disc bulge with facet arthropathy with small perineural cyst.

MRI thoracic spine 1/2/2020 report and film reviewed–indication is Hyperreflexia left greater than right lower extremity. Previously described small central protrusion C7-T1 is nearly resolved. Small central disc protrusion at T3-4 without cord impingement. At T5-6 is a perineural cyst. At T7-8 there is a focal right paracentral disc protrusion without cord impingement or central stenosis. There is also perineural cysts at T9-10 and T10-11

MRI cervical spine with and without contrast 11/4/2019 compared to 2018 MRI–Indication was numbness in hands and legs for 5 weeks: at C4-5 there is a small central disc protrusion which very minimally narrows the spinal cord. At C5-6 there is central and right paracentral disc protrusion and increase indentation on the ventral cord with mild to moderate narrowing of the canal. C6-7 there is no disc herniation. C7-T1 there is a new shallow left paracentral disc protrusion which effaces the ventral see CSF and very minimally narrows the cord. Postcontrast images demonstrate no abnormal enhancementof the cord
MRI cervical spine 10/26/2018–patient with neck pain rating down left arm since motor vehicle accident August 2018–broad-based central and right paracentral disc protrusion at C5-6. See 7 T1 there is a 6 mm perineural cyst on the left

[Donald Corenman, MD, DC]

#35147

Well, you have no significant compression of the cord or roots based upon the radiologist’s interpretation and you have a solid fusion. Your arm and neck symptom source can be determined by the injections I earlier outlined. Your lower back has some issues that would not affect the neck or arms but certainly could affect your back and legs.

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.

[mocka300]

#35151

Thank you so much Dr. Corenman for all your feedback. It is greatly appreciated!

[Donald Corenman, MD, DC]

#35152

Please keep the Forum updated on your treatment.

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.

[mocka300]

#35177

I will definitely keep the forum updated. I am unsure what I will do next. I am thinking about the diagnostic injections, but I need to call around to find a place that does it. In the mean time my neck is throbbing in pain daily. Working on the computer makes it worse and the heating pad makes it better. 80% of the pain is directly in the area of my fusion but whenever my neck hurts I also feel pressure in my throat and have trouble swallowing.I had the problem with swallowing right after surgery and was given a round of steroids. It got a little better for a short period of time. My doctor said I would have to see a specialist for it if it continued. I have yet to do that. It feels like my neck is being squeezed, almost like being choked.

I also choke on liquids, approximately 3 to 5 times a week. This was happening before surgery, but I have not told my doctor about it. I’ve been concentrating more on my pain.

Because of the fibromyalgia diagnoses, I don’t know what to think… Is the fibromyalgia making everything worse or what. My doctor said that people with fibromyalgia often have neck pain.

I had Chronic Fatigue Syndrome (CFS) in the early 90’s and was literally unable to work for three years, so I am not surprised that the doctor diagnosed me with fibromyalgia since they have overlapping symptoms. I eventually got better but continued to have some symptoms, for instance, my feet ache after only being on them for a short period of time.

The new symptoms I have in my feet and now hands is numbness and tingling, although I did have it when I had CFS in the 90’s as well.

If I were to describe where I have the most prominent “pain”, it would be 80% in my neck with 20% elsewhere. At this point I am having a very hard time doing my job, which is a desk job.

[mocka300]

#35332

Hello — 
Update: I had facet joint injections on 8/12 and had some short term relief. Instead of moving forward with the next steps, I decided to try the epidural cortisone injection on 9/23. The doctor said I may feel pain across the chest and down the arms as he does the injection, which I did feel. After a few days, I started having bad pain in my neck (shock-like and intense aching) and sharp pains in my arms, hands and fingers as well as parentheses.
 
I had an upcoming appointment with my neurologist that performed a nerve conduction test on my legs and an EMG since my neurosurgeon only did my arms and hands. The test revealed a possible pinched nerve in my left leg. He also ordered another MRI and MRA of my C-spine and an MRI of my L-spine and wrote me a referral to see a neuromuscular doctor to evaluate me for small fiber neuropathy or other neuromuscular diseases. My feet have hurt me for 30 years (since I had CFS). The difference is the numbness and shooting pains.
 
I am not able to get a follow-up appointment with him until mid December. I made an appointment with a neuromuscular doctor which is in Dec. as well. I have a follow-up with the neurosurgeon coming up.

After talking to my pain management doctor, he suggested I ask the neurosurgeon about trying a spinal cord stimulator.

The results from the current MRI of my C-spine and L-spine is below. I haven’t had the MRA yet.

HISTORY: 55 years Female 55 year old female. Neck pain with bilateral upper extremity radiculopathy for a year. No recent trauma. History of cervical spine surgery October 2021.
TECHNIQUE: Using a 3.0 Tesla magnet, multiplanar T1 and T2 weighted images were acquired. 
COMPARISON: MRI 3/12/2022, CT 7/11/2022
FINDINGS: Stable anterior fusion with plate and screws at C5-6. There is no evidence of acute compression fracture or subluxation.
Bone marrow signal shows no evidence of bone marrow edema.
Disc spaces are maintained.Spinal Cord: Normal caliber, contour and signal intensity.
C1-2: Preserved with no atlantoaxial subluxation or significant separation.
C2-3: No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.C3-4: No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C4-5: No disc bulge. Stable small central herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C5-6: Stable moderate bony ridging. Stable mild degenerative buckling of ligamentum flavum. No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. Stable moderate central canal stenosis. Stable moderate bilateral foraminal stenosis.
C6-7: Stable mild disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C7-T1: No disc bulge. New small herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.Paravertebral/Prevertebral soft tissues: Unremarkable.
IMPRESSION: Stable anterior C5-6 fusion. Stable C5-6 annular bulging, degenerative buckling of ligamentum flavum, moderate central and bilateral foraminal stenosis. Stable small C4-5 central disc herniation, mild C6-7 annular bulging, and new small C7-T1 disc herniation.

HISTORY: 55 year old female with left side lower back pain. Pain radiates down the left leg and into bot feet. Symptoms began years ago. No trauma. No prior lumbar spine surgery.
TECHNIQUE: Sagittal T1, T2 and inversion recovery, coronal T2, and axial T1 and T2 images are obtained through the lumbar spine without intravenous contrast in a 3.0 Tesla scanner.
COMPARISON: MR lumbar spine 7/23/2020.
FINDINGS: Conus medullaris ends at L1 and appears unremarkable.The kidneys show no evidence of hydronephrosis. Included portion gallbladder shows no evidence of calculi .normal size common bile duct. Small umbilical hernia containing only fat.
At L1-2, annular bulge. Neural foramina and thecal canal are adequate.
At L2-3, neural foramina and thecal canal are adequate.
At L3-4, left lateral disc herniation narrowing left L3 foramen without foraminal nerve root compression image 6 series 3. Tarlov cyst at L3 foramen on the right side image 11 series 4. Mild bilateral facet degeneration. Thecal canal is adequate.
At L4-5, annular bulge. Neural foramina and thecal canal are adequate. Small Tarlov cyst on the left side.
At L5-S1, neural foramina and thecal canal are adequate.Visualized portion of the sacroiliac joints appear unremarkable. Tarlov cyst at L5 on the right side measuring 8.2 mm at S1 on the left side measuring 15 x 13.5 mm and S2 on the left side measuring 8.5 mm and on the right side measuring 9.3 mm. Tarlov cyst scalloping the posterior margin of the S1 and S2 vertebral bodies.No pedicle edema or spondylolysis detected.
IMPRESSION: Left paracentral and lateral disc herniation at L3-4 level narrowing the left L3 foramen. Tarlov cysts in the right L3 foramen. Additional Tarlov cysts in the right L5 and left and right S1 and S2 foramina. These are usually asymptomatic. Occasionally they can be a source of nerve root compression. Findings unchanged since previous examination 7/23/2020.

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