SLWParticipantAugust 9, 2022 at 5:23 pmPost count: 6
Reversal cervical lordosis centered at C5. Anterolisthesis of C3 on C4 and C4 on C5. Retrolisthesis of C5 on C6 and trace retrolisthesis of C6 on C7.
Degenerative plate changes and loss of disc space height at C5-C6 and C6-C7. Vertebral body heights are maintained. Degenerative endplate change with relative preservation of the disc space height at C3-C4, C4-C5, and C7-T1.
There is normal signal intensity of the cervical cord.
At C2-C3: Mild disc bulge asymmetric to the right.
At C3-C4: Disc osteophyte complex asymmetric to the right. Facet joint hypertrophy, right worse than left. Mild right asymmetric spinal canal stenosis. Moderate to severe right and mild left neural foraminal stenosis.
At C4-C5: Right uncovertebral hypertrophy. Tiny central disc protrusion. Flattening of the ventral cord with indentation centrally. No cord signal abnormality. Right facet joint hypertrophy. Mild to moderate right neuroforaminal stenosis.
At C5-C6: Disc osteophyte complex asymmetric to the right. Indentation of the ventral cord without cord signal abnormality. Moderate spinal canal stenosis. Mild-to-moderate left and moderate right neuroforaminal stenosis.
At C6-C7: Disc osteophyte complex asymmetric to the left with flattening of the left ventral cord. Ligamentum flavum thickening. Mild to moderate spinal canal stenosis. Facet joint hypertrophy. Mild-to-moderate right and moderate left neural foraminal
At C7-T1: Left facet joint hypertrophy.
Multilevel degenerative changes of the cervical spine, greatest at C5-C6 where there is moderate spinal canal stenosis. Cord deformity without cord signal abnormality at multiple levels. High-grade neural foraminal stenosis on the right at C3-C4.
Stated possible need for more surgery in the future. Do not want to feel worst and of course left open that they can use non FDA methods if they deem and of course worst case scenarios.Donald Corenman, MD, DCModeratorAugust 10, 2022 at 9:16 amPost count: 8459
What are your symptoms and physical examination findings? I worry about parking a C4-7 ACDF on top of a “C7-T1: Left facet joint hypertrophy”.
Dr. CorenmanSLWParticipantAugust 10, 2022 at 11:01 amPost count: 6
Hi Dr Corenman,
Thank you so much,
Mostly the pain in the neck, shoulder, some tingling and pain in arms and fingers, at times back of head hurts expecially laying back in chair. I have had vertigo short minute spans and adjust head and stops. 2016 trip to hospital 1st time uncontrollable sickness, no findings. When I was working on feet 12+ hrs legs would not want to go and hurt, at times pain would radiate out the right side of my neck. I have tingling, numbness in toes both feet and have had regular muscle spams back of legs and feet close to a year, occasionally now. Originally went to Dr in Feb. I thought having lower back issues and neck would both be addressed. So I literaly had to choose, walking issues I chose back, I have had on/off issues for the last few years. I have facial tingling, top of head tingling and even outer ears can hurt. ENT no ear problems, have pain in front of neck. I have not worked since the end of December. I had 2 incidents in November and December of last year back pain, neck pain and hard getting in and out of car. I have had previous back surgery in early 80’s it was thought at that time it was growing pains. I have on and off sciatica pain that occurs in both legs including hips. Recently going now to foot doctor over the numbness, 1st visit. I loose balance out of no ware and last month fell on concrete with small fracture in elbow, healing well no cast.
I get stiff and hurt if sit to long, I hurt if up to long, can be walking fine and suddenly just take a turn. I had back surgery for spondylolisthesis, had knot that protruded and sciatica pain 1 leg got really bad, if no surgery at that time I would be crippled by 30. All went well. I recently rubbed by knee and now experiencing the tingle down the lower front of leg. I have had shots in my back twice. I am at lost of what comes from my back now and what comes from my neck. I appreciate your feedback so much. I am 61 and have worked retail all my life in a very demanding atmosphere, from unloading trucks weekly, pushing freight, running registers, computer work covering shifts and sitting at computer in length. I do have barrettes and ear pain, I do not go to the Dr for ear pain anymore because I never have an ear infection. Went to ENT for pain in neck and I have a cir. bar at C5, I believe referred to as slight dysplasia. I’m sure I left something out. Thank you againSLWParticipantAugust 10, 2022 at 11:51 amPost count: 6
Awake alert and oriented x3. No acute distress.
Hearing is intact to the spoken word. Respirations are unlabored.
Global sagittal and coronal balance are within normal limits.
Skin on the neck is healthy with no rashes, lesions or surgical scars.
No excessive kyphosis or scoliosis.
No palpable abnormal masses or nodules. No point tenderness, no step-off.
Cervical range of motion is limited by pain and stiffness.
Bilateral upper extremity range of motion is within normal limits with minimally increased pain.
No obvious shoulder, elbow, or wrist pathology bilaterally.
Right upper extremity muscle tone and strength are normal.
Left upper extremity muscle tone and strength are normal.
Sensation to light touch is intact in bilateral upper extremities.
Bilateral upper extremity reflexes are normal and symmetric with no long tract signs.
Bilateral upper extremities are well perfused with no signs of DVT.
AP and Lat upright C-spine films in office were independently reviewed and show cervical spondylosis with retrolisthesis of C5
CT Cervical spine shows severe spondylosis worse from C5-7 with a grade 1 spondylolisthesis at C3-4, C4-5.
MRI Cervical Spine shows severe central stenosis and bilateral foraminal stenosis C5-6SLWParticipantAugust 10, 2022 at 12:14 pmPost count: 6
Dr Corenman this is my lumbar spine
CLINICAL INDICATION: Back pain or radiculopathy, > 6 wks
COMPARISON: CT lumbar spine same day
FINDINGS:Severe/grade 4 anterolisthesis of L5 on S1 with bilateral L5 pars defects. Leftward curvature centered at L1-L2.
Severe degenerative endplate changes related to the anterolisthesis of L5 on S1 with partial osseous fusion of the L5-S1 endplates. Degenerative endplate changes and loss of disc space height within the lower thoracic spine and at L1-L2 and L2-L3.
Vertebral body heights are maintained. Osseous fusion of the posterior elements from L3 to S1.
The conus medullaris is normal in morphology and terminates at L1.
At L1-L2: Disc bulge asymmetric to the right. Facet joint hypertrophy. Mild spinal canal stenosis. Moderate right and mild left neural foraminal stenosis.
At L2-L3: Disc bulge asymmetric to the left. Facet joint hypertrophy. Mild right neuroforaminal stenosis.
At L3-L4: No spinal canal or neuroforaminal stenosis.
At L4-L5: No spinal canal stenosis. Mild bilateral neuroforaminal stenosis.
At L5-S1: No spinal canal stenosis. Moderate to severe right and moderate left neural foraminal stenosis.
IMPRESSION:Severe/grade 4 anterolisthesis of L5 on S1 with partial osseous fusion of the L5-S1 endplates. Moderate to severe right and moderate left foraminal stenosis at this level. Outside of this, no high-grade spinal canal or neuroforaminal stenosis.
Review of Systems
Cardiovascular: Positive for leg swelling. Both legs
Genitourinary: Positive for frequency and urgency.
Musculoskeletal: Positive for back pain, gait problem and neck pain.
Neurological: Positive for dizziness, weakness and numbness.
Psychiatric/Behavioral: Positive for sleep disturbance.
All other systems reviewed and are negative.
Right lower extremity muscle tone and strength are normal except 4/5 EHL
Left lower extremity muscle tone and strength are normal, except 4/5 Hamstring
Sensation to light touch is intact for bilateral lower extremities.
Lower extremity reflexes are normal and symmetric with no long tract signs (babinski or clonus).
Lower extremities are well perfused with no signs of DVT.
Tender to palpation bilateral troch R>L
DEXA scan shows a T-score of -1.6 consistent with osteopenia.
Lumbar CT scan shows a solid fusion L5-S1 with grade 5 spondylolisthesis at L4-L5
Lumbar MRI shows mild to moderate central and lateral recess stenosis L1-L2 and L2-L3.
DEXA scan shows a T-score of -1.6 consistent with osteopenia.
Had physical therapy and pain management injectionsDonald Corenman, MD, DCModeratorAugust 10, 2022 at 3:52 pmPost count: 8459
Your lower back has a severe deformity (“Severe/grade 4 anterolisthesis of L5 on S1”) which is almost your lumbar spine falling into your pelvis. You do have a bridge of bone protecting you but that may not help as much as it sounds. You have expected foraminal stenosis at this level L5-S1. If you can live with this, you can avoid a significant surgery but you will have to adapt accordingly. You do have osteopenia (soft bone) making surgical correction more difficult.
You don’t have spinal cord signs (“Lower extremity reflexes are normal and symmetric with no long tract signs (babinski or clonus)” and “Bilateral upper extremity reflexes are normal and symmetric with no long tract signs”. You do have gait disturbance but with your large slip at L5-S1, that can be explained.
A C4-7 ACDF might be in your future and be helpful but you have degenerative changes above and below so remember this might not be your last surgery. I would stay away from a corpectomy as I don’t think you need it and they are harder to heal.
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