[Brandy]

#27787

Hi Dr Corenman
Thanks so much for your time in helping everyone. Does this seem weird had myleogram done in August 2016 and MRI done Dec 2017
Myleogram:
C2-3 no evidence of discrete herniation or stenosis
C3-4 minimal disc bulges seen without discrete stenosis
C4-5 mild broad based disc bulges seen causing effacement thecal sac. There is also evidence of posterior narrowing noted on the left side along the left lamina. Discrete impression is not seen on the cord but there is thinning of the csf space. Bilateral uncovertebral hypertrophy is seen with neural foramen narrowing more so on the left
C5-6 surgical site is widely patent. No discrete impression is seen of the thecal sac. The neural foramen are widely patent. The laminectomy site is widely patent.
C6-7 surgical site widely patent with widely patent neural foramina bilaterally. The Pericles screws are well placed
C7-t1 no discrete disc herniation is noted
Impression : broad based disk bulge at c4-5 with bilateral neural fora I also narrowing more so on the left. There is mild impression on the thecal sac posterior
Y at the left lamina at this level which might be from thickening of the ligament.

MRI dec 2017
There is loss of the normal cervical lordosis which may be secondary to positing. The visualized vertebral body heights are maintained. There is loss of intervertebral disc space height at the c4-5 and c7-t1 levels the visualized vertebral body marrow signal is appropriate for patient stated age no abnormal signal is identified within the cervical cord. The prevertebral soft tissues are within normal limits the cerebellum tonsils are normal in position. There is mild degenerative changes at the c1-2 level
C2-3 there is minimum disc bulge there is no central canal stenosis or neural foramen narrowing
C3-4 there is minimum disc bulg eccentric to the right. There are degenerative changes involving the facets bilaterally. There is mild bilateral neural foramen narrowing. There is no central spinal canal stenosis
C4-5 there is ossous ridging with a moderate sized central disc herniation with extruded disc material extending superiority behind the c4 endplate and indenting the the all sac. There is bilateral uncovertebral joint and degenerative facet disease left greater than right. There also is ligamentum flavum hypertrophic indenting the dorsal aspect of the thecal sac. This combination results in mild central spinal canal stenosis. There is moderate bilateral neural foramen narrowing
C5-6 the patient is status post fusion
C6-7 the patient is status post fusion
C7-t1 there is minimum disc bulge there is no central spinal canal stenosis or neural foramen narrowing
Impression: patient status post cervical fusion c5-7. Osseous riding with moderate sized central disc herniation at c4-5 indenting the thecal sac with mild stenosis. Minimum disc bulges at c2-3 c3-4 and c7-t1

Ct scan dec 2017
Findings: examination demonstrates patient to be status anterior plating c5-7 levels with screws fixation at c5 and c7 levels there is additional retained right sided screw fragment within the superior portion of the c7 vertebral body and correlation with surgery history the patient is status post posterior cervical fusion with lateral mass rods spanning the c5 through c7 levels with interpedicular screws at the c5 and c7 levels. The right sided c7 screw projects along the medial cortex of the Pericles. The patient is status post corpectomy at the c5 through c7 levels with a interbody cage spanning the inferior c5 through the superior c7 levels metallic artifact from the patients orthopedic hardware obscures the detail. The patient is also status bilateral laminectomy at c5 and left hemilaminectomy at c6. There is loss of the normal cervical lordosis which may be secondary to positioning. The visualized vertebral body heights are maintained. There is loss of intervertebral disc space height at the c4-5 and c7-t1 levels. The prevertebral soft tissues are within normal limits. There is mild degenerative changes at the c1-2 level.
Limited evaluation of the orbits demonstrates irregularity of the medial walls bilaterally right greater than left with medial displacement of the medial reclusive muscles bilaterally which appears thickened. This may be secondary to previous trauma or surgery.
Impression: post anterior and posterior fusion c5-c7 with interbody cage. Please see comment regarding hardware
How would you treat. I have done th facts and radio frequency ablation very short lived. I have arm pain, bad headaches, numbness, weakness, my arms and legs go paralized like and can last up to an hour where you can not move them at all. Bladder and bowel probl ms Also have lower spine problems l4-5

[Brandy]

#27799

Hi Dr Corenman
I got struck in back from head to knees had one surgery in 2000 and 2003. It was a work injurymy first surgery comp Dr screwed up his own X-rays said hardware was broke and a question of the fusion but after having the 2nd surgery which was a front of neck approaches and than I was flipped and they did the back of the neck. I was told by the neurosurgeon and orth Dr that did the surgery that the plate was bent in my neck and both fusion were fractured all the way five of the six screws were broke.
Here is a earlier from 2014 MRI
2014
Bone marrow hyper intense signal on the left side of the c4 vertebral body on stir images which was not evident on prior study.
A Ct and bone scan was done to check that and all was fine
Fractures none
Disc height normal at all cervical levels
Ostephytes mild marginal osteophytes vertrally at c4-5
C2-3 no disc bull seen the neural foramonia are patent
C3-4 mild disc bulge with protrusion into the right ventral epidural space without cord deformity. The neural foramina are patent
C4-5 mild disc bulb without cord deformity. The neural foramina are moderately stenotie bilaterally
C5-6 fused level no cord compression is evident. The neural foramina are patent.
C6-7 fused level no cord compression is evident. The neural foramina are patent.
C7-T1 no disc bulg or herination is seen. The neural foramina are patent
Cord no abnormal signal is seen within the cord at any level
Impression: cervical fusion at c5-7
Disc pathology at c3-4 and c4-5 as noted without cord compression
Fora in all stenosis is significant bilaterally at c4-5
Hyper intense signal in the left side of the vertebra body at c4, not evident on the prior MRI scan referenced above . Corrrelation with Ct is recommended to elevate the bony architecture of this lesion. Bone scan is recommended to exclude other such lesions.
Ct scan and bone scan were done no other lesions on bone scan and the Ct scan was a arthritic bone.

Can you give your opinion or advice as this is worker’s comp and I was having MRI done on another body part and was told they had to place me on hold as they had to find a place that dose low dose only, I was like it’s a MRI not Ct scan. So I don’t even now if these are what it really shows as how can some of the stenosis just go away. Should I go to a prepay place and get a new MRI I think it’s 500.00 with contrast and no insurance. Can you tell me how much it is to have you re read these just the MRI from dec 2017 and Ct myleogram 2016 and prior MRI 2014?
i get headaches from back of neck into head, pain down arms along with numbness, weakness and tingling of arms. Had emg done in 2016 which showed one arm c5-6 and the other arm c7-8. My arms and legs will go completely numb where you can not lift or turn palms over it can last up to a hour it happens in both legs also. Saw primary Dr no stoke as it’s both arms both legs. It happens up to twice a month. Comp doesn’t let me see the surgeons, I last saw neuro Dr last feb and he flipped when he saw the films and said he needs new ones but it takes comp forever to get them. Neuro did say over a year ago that he was going to do surgery from the back of neck but that was before this last MRI so does this look like surgery to you and if so what level c4-6. Thanks for any opinions. Your in colerado im on east coast, what do you think maybe I’ll have to take a family trip. I do have bladder and bowel issues but I also have lower back but was told the bladder and bowel was from the neck cervical myelopathy I know I had that before the second surgery which was a double one front of neck and than flipped for 2 no part of that surgery from back of neck.
Thanks in advance for any thoughts.

[Donald Corenman, MD, DC]

#27898

You underwent an initial ACDF surgery at C5-7 and the fusions failed. That is not uncommon with certain techniques. You then had a revision front and back surgery which sounds like it was successful.

You need an interpretation of the upcoming MRI. All MRIs performed have a radiologist who reads them and publishes a report. Instead of paying my long-distance consultation fees, you can simply post this report here and I will gladly go over it with you for free.

You note “My arms and legs will go completely numb where you can not lift or turn palms over it can last up to a hour it happens in both legs also” does not fit with your current imaging studies. Did you have cervical canal stenosis and spinal cord compression/myelopathy that caused your first surgery?

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.

[Brandy]

#28012

Hi Dr Coreman

Yes I did have myelopathy as the first surgeon messed me up bad the plate was bent in my neck and was told by the last two surgeons who Fixed that mess up and took the hardware out broken screws they did a corpectomyy with inter body cage from c5-7 than flipped me and did a bilateral laminectomy at c5 and left hemilaminectomy at c6
The MRI exam demonstrates the patient to be status anterior cervical plating at c5-7 level with screw fixation at c5 and c7 levels. The patient is status post corpectomyy with inter body cage spanning c5 through the superior c7 levels. The orthopedic hardware is better evaluated on the patients concurrent ct and prior cervical x-rays. Metallic artifact from the patients hardware obscures fine detail. The patient is also status bilateral laminectomy at c5 and left hemilaminectomy at c6.
New MRI without contrast done in Jan. This year said: there is loss of the normal lordosis. The visualized vertebral body heights are maintained. There is loss of intervertebral disc space height height at c4-c5 and c7-t1 levels. The visualized vertebral body marrow signal is appropriate for the patient’s stated age. No abnormal signal is identified within the cervical cord. The cerebellar tonsils are normal in position. There are degenerative changes at the c1-2 level.
At the c2/3 level there is disc bulg. There is no central spinal cord stenosis or neural for amen narrowing.

At the c3/4 level there is disc bulge eccentric to the right. There are degenerative changes involving the facets bilaterally. There is bilateral neural for amen narrowing.

At the c4/5 level there is osteosarcoma ringing with a moderate-sized central disc herination with extruded disc material extending superiority behind c4 end plate and indenting the thecal sac. There is bilateral uncovertebral joint and degenerative facet disease left greater than right. There also is ligamentum flavum hypertrophy indenting the dorsal aspect of the thecal sac. This combination results in central spinal canal stenosis. There is also moderate bilateral neural for amen narrowing.

At the c5/6 level patient is status post fusion
At the c6/7 level patient is status post fusion
At the c7/1 level there is disc bulg. There is no central spinal canal stenosis or neural foremen narrowing at this level.

Impression patient status post cervical fusion c5-7. Osteosarcoma riding with moderate sized central disc herination at c4/5 indenting the thecal sac with spinal stenosis. Disc bulges at c2/3 c3/4 and c7/1
See the addendum at the top of this report. It may contain additional important information or changes.

Ct scan done same day Jan this year said:
Technique multiple axial sections were obtained from the mid orbits to the sternoclavicular joint. Sagittarius and coronal reformation were obtained from the axial data set. The images were reviewed in soft tissue and bone Windows. 3D reconstructions were obtained on a independent workstation to better asses the cervical hardware.
Comparison MRI cervical spine same day Jan 2018 and cervical X-rays February 2017.
Findings: the ct examination demonstrates the patient to be status anterior plating c5-7 levels with screw fixation at c5 and c7 levels. There is an additional retained right sided screw fragment within the superior portion of the c7 vertebral body and correlation with surgical history is recommended series 80249 image 25 and series 5 image 45. The patient is status post posterior cervical fusion with lateral mass rods spanning c5-c7 levels with interpedicular screws at the c5 and c7 levels. The right sided c7 screw projects along the medial cortex of the pedicel series 5 image 43. The patient is status post corpectomyy at the c5 through c7 levels with a inter body cage spanning the inferior c5 through the superior c7 levels. Metallic artifact from the patient orthopedic hardware obscures fine detail. The patient is also status bilateral laminectomy at c5 and left hemilamilaminectomy at c6.
There is loss of the normal cervical lordosis . The visualized vertebral heights are maintained. There is loss of intervertebral disc space height at the c4/5 and c7/t1 levels. The perverse real soft tissues are within normal limits. There are degenerative changes at the c1/2 level.
Limited evaluation of the orbits demonstrates irregularity of the medial walls bilaterally right greater than left with medial displacement of the medial reclusive muscles bilaterally which appears thickens. This may be secondary to pRevious trauma or surgery and clinical correlation is recommended.
Impression status post anterior and posterior fusion c5 thRough c7 level with internode cage please see comments regarding hardware.
This latest MRI and ct scan were not compared to any prior MRI or ct or the ct Myleogram only X-rays done in February 2017 and MRI and ct done same day Jan 2018.
My symptoms are sever headaches that last days not migraines as it starts from neck into back of head and goes to top and sides, pain down both arms, pain to both shoulders and shoulder blades. I get electric shock like pain down arms more so if I look down. Nick always hurts and feels stiff. Fingers tingle and go numb. Arm strength is weal so is the grip as if opening a jar. Get pain behind eyes when neck pain is bad and the headaches. My handwritten has changed seems to have gotten very sloppy, hard button shirts. I also have bladder and bowel issues. I do also have lower back herination which they had wanted to do a plif on l4-5 but I’m sure you no how comp works and now it’s more levels in the lower back also. I do have a righ rotor cuff part t at f on the d lay in comp doing surgery on the right shoulder and no it’s also has a partial tear, but even before the tear to the right arm I still had pain going don both arms into fingers. EMG done a couple years ago did show something with the nerv s that were fused.
If you don’t mind me asking how would you treat this?? I’m so tired of the headaches, neck pain and stiffness, arm pain and weakness along with tingling and numbness.
When I saw a neurosurgeon and he saw the prior MRI ct scan and ct myl organ he flipp d and wanted to know hat they said when scanning me and saw this he said it was bad and no spinal fluid getting by one level he wasn’t even going to let me leave the hospital but was able to convince him by saying look how long comp took to okay the last surgery hen they knew the plate and hardware were broke they made me wait over a year and h said I remember that and look at the problems we ran into. I do not know hat problem I was told the surgery to longer it was almost 12 hrs I know they had to use a robotic thing to get the bent plate and broken in half screws out, they were surprised after it that I as even able to walk. I said I complained of the leg pains. I know when the dr was not going to let me leave last year that my reflexes were all very hyper both arms and legs. Is there anything besides surgery? I have done the facet inj cations, nerve blocks, radio frequency ablutions any relief was short term.
Thank you so much for your reply. How much to send you the last two MRI and ct scan and Myleogram. I know the cr Myleogram done in 2016 which I have gotten worse since than but I know comp didn’t tell th m what to write for that, my comp adjustor tells the place when I er I have any test done to use low dose only they did that with the MRI to look for a tear they were told low dose only but it did show a tear on the 1.5 strength even though I was told they use a higher magnet when looking for tears. I might pay to have MRI with contrast done. As my primary dr said this last MRI should have been done with contrast since th ct Myleogram showed something with limited spinal fluid getting by one level and a lot of stenosis.
Thanks so much for your opinion how would you treated this?

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