[jasatkin]

#23144

Dear Dr. Corenman,

I am desperate for advice. About a year ago, I began to seek help for my symptoms. It began as sore throat symptoms, and pain in the neck. This progressed to a feeling of unsteadiness, especially with my eyes closed. I was also getting parasthesias in both of my hands and I would drop things all the time. In November of last year, I began getting leg symptoms, they just felt tight all the time. Also began getting tightness and some weakness in my arms as well. I had x-rays done which showed osteophyte development at c5-6 and c6-7. I went to a spine specialist who told me there was no way to get leg symptoms from my neck, he suggested a brain MRI. I did that, as well as an MRI of my cervical spine. The brain MRI was normal with only 1 or 2 punctate foci of subcortical white matter T2 hyperintensity in the left frontal lobe. The cervical spine MRI results are as follows:

FINDINGS:

Alignment: Straightening of the normal cervical lordosis throught the mid cervical spine c4-7, no significant subluxation.

Bone marrow: Endplate marrow signal changes, Modic type 1 and type 2, fibrofatty change noted c6-7. Otherwise generally unremarkable.

Vertebral bodies: Normal

Cervical Cord: No facal signal abnormality to suggest demyelination.

Visualized paraspinous structures: The visualized soft tissues are unremarkable.

C2-3: Normal for age.

C3-4: Normal for age.

C4-5: Minor grade 1 shallow central annular bulge. No acquired stenosis or neural impingement.

C5-6: Moderate severe disc space narrowing with grade 1-2 diffuse bulge and marginal osteophyte comples associated with uncinate process spurring right greater than left. This produces moderate bilateral foraminal stenosis which is slightly more severe on the left. Mild central canal stenosis without definitive cord impingement or displacement.

C6-7: Grade 1 broad based bulging disc is present associated with bilateral uncinate process spurring which appears slightly more severe on the right. This produces miled to moderate foraminal stenosis but not as severe as at C5-6. Similar findings are noted on the left.

C7-T1: normal for age without stenosis.

Impression:
1. Degenerative spondylosis c5-6 and c6-7 with broad-based bulging discs at each level, marginal and uncinate process spurring.
2. This produces formainal narrowing at each level, moderate at c5-6 greater on the left and mild to moderate at c6-7.

I next saw a surgeon who stated that the stenosis was definitely not “mild”, the AP diameter is 7 mm, but again, no cord signal changes. Because of this, he didn’t think my neck was the problem. I next went through months of testing from a neurologist. I had EMG’s, EEG’s, MRA’s of the head and neck, MRI’s with contrast, MRI’s of the thoracic and lumbar spine, blood tests for Lyme disease, Lupus, etc, I also had a spinal tap done. All of the tests were normal. I also got a second opinion from a different neurologist, they both agreed that my neck was the problem.
I went back to the surgeon, who now said he would do the surgery, he recommended a 2 level ADR. My insurance would not pay for it, so we fought it for 2 months. Symptoms continued with neck pain that radiated out across my shoulders and into my deltoids, sometimes the biceps. Also still had the spasticity in both hamstrings and began to get some weakness in my quads. Hyperreflexia in the legs and depressed reflexes in my arms. I finally had surgery on September 1st. It seemed to go well. Symptoms were somewhat improved for about a month. Now I seem to be regressing. I am extremely anxious and desperate for some sort of resolution. I was hoping for your opinion of my circumstances, and any advice on how to proceed would be greatly appreciated.
Thanks in advance for any help.

Jason

[Donald Corenman, MD, DC]

#23151

The canal narrowing is a problem. Not having cord signal chance does not mean that there is no cord dysfunction. The physical examination is very important here. Do you have long tract signs (hyperreflexia, clonus, Hoffman’s sign, inverted radial reflexes, positive Rhomberg’s test-balance problems and or a positive triangle test). If these signs are present with your symptoms and the narrowing of the canal as noted, you probably have myelopathy. This means you need surgery for your neck.

I never recommend an artificial disc replacement (ADR) with narrowing (stenosis) present as the ADR allows motion and motion is what causes cord damage. I always recommend a fusion as I want to stop the motion (which also causes spurs to reform and in a narrowed canal can cause recurrent stenosis). The only exception is where there is a large disc herniation in a generally large canal where the disc herniation removal will restore the large canal and an ADR is acceptable. This is not your case.

With recurring symptoms, if you were my patient, I would order a new MRI or CT myelogram.

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.

[jasatkin]

#23153

Thank you very much for the reply. I do have some long tract signs, most noticeably hyperreflexia in my legs, and I was told “depressed” supinator reflexes. Many of the other signs seem so subjective that there is no agreement among the many doctors I have seen. Scattered among my files are the following statements: positive spurlings bilaterally, non-sustained ankle clonus, positive Babinski bilaterally as well as a few beats of clonus bilaterally.
I also have some degree of balance problems, in fact one of the first things I noticed was that I felt like I was going to fall over in the shower when I closed my eyes to rinse my hair out.
A few final questions if I may. As I mentioned, I had 2 level ADR surgery on Sept. 1st. If my neck wasn’t the problem, then it seems to me the symptoms should not have improved after surgery, is that correct? I have not been able to find much in the way of information about recovery after having surgery for myelopathy. I’m wondering if it is normal for the symptoms to come and go as the spinal cord heals? Is 6 weeks long enough to gauge recovery? Or do I just need to be more patient?
I did check with my insurance and you are in my network! I realize now that ADR was probably not the best option for me, but now that it is done, do I need to get it fused or wait and see how it goes?
Thanks again.
Jason

[Donald Corenman, MD, DC]

#23155

The standard expectation for myelopathy surgery is that surgery prevents further progression of the cord damage. That being said, I have probably performed 500 spinal cord cervical decompression surgeries (as compared to about 1800 cervical nerve root decompressions) and a great majority of these patients had significant improvement of their myelopathy.

For cord injury, the maximum time that improvement takes is about a year. That being said, most of my patients had improvement much sooner. Give yourself some time to heal. Please report back in about 6 weeks.

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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