[justenough]

#9567

I have a question. If a c5-6 disc CENTRAL, osteophyte with small herniation is making “obvious contact with the cord with small indention in the cord, yet no obvious increased signal within the cord, in addition in same level opposite c5-6 there are 2 PLL buckling, and patient has hyperfexia, in all upper extremities , disequilibrium, more evident on static standing, abnormal romberg, no positive babinski or hoffman sign, absent bilateral ankle reflexes ( female age 47 slim 5’3 109lbs ) would it be feasable to intervene to ensure the disc region is secured away from cord, or wait until OBVIOUS hyper intense increased signal develops, which may cause irreversible damage at that point.

There is also cervical stenosis of this region, 4 years prior an MRI report stated 9mm stenosis, this RECENT MRI was read as unremarkable, despite the findings I just described.

I am an imaging specialist ( not MRI ) however, these are my own images, and I have studied them, the cord and disc are well seen, as is the obvious contact and indention of central cord, and the 2 levels of PLL buckling.

I hope I have stated this question properly. I hope you could answer please.

[Donald Corenman, MD, DC]

#9568

There does not have to be spinal cord signal change present to indicate the presence of cord dysfunction and the beginnings of myelopathy. What has to be present is cord compression, symptoms of myelopathy and physical examination findings to diagnose myelopathy.

You have cord shape distortion, stenosis (narrowing of the canal-you do not reveal how severe) and symptoms of myelopathy (“disequilibrium, more evident on static standing”). Add to that physical examination findings (hyperreflexia and positive Rhomberg’s) and you could have developed myelopathy. There are typical findings that you do not present with (Hoffman’s sign) but the total findings indicate cord irritation.

You need a spine surgeon to look at you carefully. A prior MRI noting a 9mm canal fits with imaging definition of cervical stenosis-the findings needed to confirm a diagnosis of myelopathy.

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.

[justenough]

#9571

Dr. Corenman,

It means a lot you took the time to respond and expound as well.

The prior MRI 4 years ago revealed and as the radiologist dictated mild cervical stenosis of 9mm, C5-6 disc herniation abutting spinal cord.

( terminology can make a difference )not sure what abutting means, but the disc was contacting cord at that point, ( my eyes see it resting on cord, no CSF can be seen at that one area, but cord had no indention at that time.

Fast forward………..progressing symptoms………new recent Cervical MRI and that same C5-6 abuttment, has now indented the cord, not drastic, but very evident, in addition as said the PLL ( I believe has 2 levels of bucking, this is lateral and opposite of the DISC side, so hope that is the PLL, there IS still adequate CSF seen in that area, unlike the Disc protrusion that is indenting the cord, but the combination of the 2 decrease the space of CSF as a whole and contribute to the stenosis.

However, the radiologist that read this most recent MRI dictated it as ” unremarkable Cervical MRI ”

The diagnosis the rad saw to read was gait abnormality, and to rule out cord compression.

The reason it was ordered was the Doctors findings of positive Rhomberg, hyperflexia,granted no positive babinski, or hoffmans sign, but my father has obvious cord compression on both sides ( disc and Ligamentum flavum ) maybe I made error in anatomy and terminology, be he has a very ugly MRI with increased signal in his cord yet his hoffman and babinski is normal as well. He also does not have the disequilibrium problem I have and he is 79!

Here is my problem…. standing static as said ..for more then 10 seconds I am rocking and swaying, griping toes and feet to ground to keep upright, it is the most horrific feeling……..taking shower, terrible, scary, I have to hold wall with one hand, but when i have to wash and rinse hair I need both arms, which makes me raise them and then my spine and legs stiffen, I must grip feet and legs so hard to keep upright….anything I do that I have to stand still, raise arms, makes me 70% worse……….walking in dim light or darkness…….forget it!

When I walk ….from point A to B, as long as I am walking and staying in motion it is not as bad, but it seems as if my legs at times during this walking kinda quickly give way, briefly, almost like my hip malfunctioned …also I do not walk with wide gait, but I think because of my hips and sacro I take shorter smaller steps ( side note, for some reason I have neuropathy in both feet, ( I also have bilat carpal tunnel tested through EMG ) my feet have not been tested and the issue seems be more on outside of ankles, not inside and just touching the skin sends millions of little shocks that spread like fingers down the top of foot to toes…also absent ankle reflexes….but I have not had an EMG of ankles and feet, but I know its neuropathy, my wrists have same thing happen even if I lightly scrath both insides of wrists…

I wish I could have you look at the actual films…….would you have read the cervical MRI as ” unremarkable ” That is the wording, that is it.

[Donald Corenman, MD, DC]

#9579

Your imbalance can originate from the beginnings of myelopathy but can derive from peripheral neuropathy. See the website for an explanation of this disorder.

I never like to understand an image of an MRI from someone else’s description as their choice of works does not paint a picture for me. If there is a rind of CSF around the cord at every level including the “tight” level and the cord is not deformed, the stenosis at that level would be considered “mild” in my classification scheme. Cord deformation or loss of one sided CSF would make the stenosis “moderate” in my reading.

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.

[justenough]

#9609

I want to try a chiropractor with a drop table ( no twisting the neck with the hands type thing, just going down the neck and spine and trying to straighten it.

With the images I sent and with the disc indenting the spinal cord, could going to chiropractor cause any harm, I am desperate for any help with how I am feeling and functioning with my symptoms.

If I read back at the c-7-8 where the first thoracic meets the cervical there is a severe curve there, my head tilts to right. My left SCM is wide hard and elongated on LEFT, the right shoulder droops and as said head tilts to right and forward.

I feel like maybe its neck scoliosis upper with the top thoracic that is causing this, and why it stays this why seems fixed, but maybe of the chiropractor tried to move the bones straight there it would help….I could care less how my head tilts and sits ( the way I look like that ) its the symptoms and I have been diagnosed with cervical dystonia and I have severe TM joint dislocation on right, add to my ( considering my head tilts to right, shoulder and scapula 2 inches lower on right, jaw joint has extreme deviation to right, it seems as if the bones at c-7-8 and first thoracic all contribute to this and I have never had a standing XRAY from back to see this curve, but you can follow it with feeling it, its an extreme bone curve right at base of cervical and first thoacic about 3 inches…

I am so desperate, I am willing to let a chiro try and click those bones straight to see if I get any relief from the disequilibrim . I am taking the films with me today so she can see it first, but would appreciate your input…

[Donald Corenman, MD, DC]

#9612

Chiropractors do not “straighten” the spinal column. The action of the manipulation (the adjustment) increases motion of a segment but there is no “the vertebra is in or out”.

Drop tables have advantages and disadvantages. The “drop” feature allows greater acceleration of the speed of manipulation and a quick “stop” of motion. This allows more force generation which I’m sure you can understand is both good and bad.

The good is that the chiropractor needs less force from his hands to generate a greater force of movement (good for the chiropractor as he or she needs to generate less force for the same motion as a DC without a drop table).

The bad is that force generation is amplified. If a chiropractor uses the same speed and force as a standard manipulation but uses this force on a drop table, amplification of force can cause injury to the structure manipulated. I have seen these injuries from a drop table so you have to be careful as to who you choose to manipulate you.

Your description of your alignment sounds like you have a scoliosis. This will cause a dropped shoulder and larger muscles on one side of the spine.

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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