Chronic neurogenic changes

///Chronic neurogenic changes
Chronic neurogenic changes
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  • Madoak
    Participant
    Post count: 5

    Dear Sir,
    I am a 53 year old woman from the UK who had a c5/6 fusion in 2013. I have slowly lost functional strength in my right hand and have confirmed rhomboid muscle palsy due to an ‘unknown’ dorsal scapula dysfunction. This makes it very difficult for me to hold up my head. I have quite severe upper back pain. The question is, I was told categorically that the loose screws in my neck (all) and the complete lack of fusion is nothing to do with my deteriorating condition. Would the lack of fusion etcetera be anything to do with this do you think? My G.P. has basically told me to get over it; however, I continue to deteriorate. I also have bouts of difficulty with swallowing (almost as if I’m having a stroke) and speaking also. I have chronic neurogenic changes on EMG but on repeat stimulation only (it does not show on single fibre). This is in the entire back area of my right back and shoulder and also in my hand. I look forward to any insight you can give me.
    Yours truly

    Donald Corenman, MD, DC
    Moderator
    Post count: 6457

    There are many disorders that can cause your symptoms. One obviously would be the C5-6 pseudoarthrosis (“loose screws in my neck (all) and the complete lack of fusion”) as this level with a pseudo can cause spur formation that can recompress the C6 nerve and cause hand dysfunction. The loose screws can cause esophageal irritation and dysphagia (swallowing difficulties). See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C6 nerve can cause.

    Also, there are syndromes that can cause muscle weakness like Parsonage Turner Syndrome (https://neckandback.com/conditions/parsonage-turner-syndrome-neck/) and some of the intrinsic nerve disorders but I would first focus on the pseudoarthrosis.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Madoak
    Participant
    Post count: 5

    Thank you so much for your response – it was very helpful and Inhave just had a CT scan. Hopefully now we can see the extent of the problem.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6457

    Please keep own contact to let the forum know follow-up.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Madoak
    Participant
    Post count: 5

    Hello Dr Corenam, this is an upadate of my current situation. I am due to see a neurosurgeon tomorrow to discuss the ct scan of my neck (loose screws and failure to fuse). In the meantime my previous orthopedic doctor asked to see the scan and came up with the following:
    “…(there is) a halo around the screws in the more cranial vertebral body with asymmetry of the cervical disc replacement and lateral osteophytes on the left side. The problem is how to understand the relationship between this possible failure to fuse and therefore inter-segmental instability with pain from a focal lesion around the scapula, which, I cannot demonstrate.”
    I think what is baffling the doctors is that all my symptoms are on, and always have been, on the right side, now resulting in a practically useless right hand, immovable right shoulder and therefore difficulty holding my head up. I have been tested for myasthenia and am negative. I had no health issues prior to my accident. I have a very high pain threshold and am more concerned about the neurological deficits as opposed to the pain, as these have a greater impact on my life. A thoracic surgeon is prepared to do an investigative procedure of the brachial plexus in February to determine whether the intitial symptoms were caused by thoracic outlet syndrome. I do have electromyography demonstrated by a pre-ganglionic lesion affecting the cervical myotomes. Perhaps now two problems? Thoracic outlet plus segmental instability caused by failure to fuse? Very hard to know how to approach the interview with the neurosurgeon tomorrow. Do you have any views on the above? Regards. Laila

    Donald Corenman, MD, DC
    Moderator
    Post count: 6457

    “A thoracic surgeon is prepared to do an investigative procedure of the brachial plexus in February to determine whether the intitial symptoms were caused by thoracic outlet syndrome”. This statement worries me. Is there a definite diagnosis of thoracic outlet syndrome or is this an “exploratory procedure” which draws a red flag?

    Your next statement indicates a lack of a correct diagnosis (“all my symptoms are on, and always have been, on the right side, now resulting in a practically useless right hand, immovable right shoulder and therefore difficulty holding my head up”). A consultation with a careful, thorough neurologist would be the next step.

    Diagnostic blocks (SNRB or TFESI) would be indicated to look for pain sources.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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