[justenough]

#9613

Dr. Corenman,

You make a lot of sense and have such a good understanding……did you happen to see the images I sent to the email notice I get when you respond to my message. I sent it through a reply in that email as an attachment. I know its hard from that image to see the acutal indention in C5-6 but there is no CSF at all in that area and the ligamentum flavum are buckled, that mri was read as normal MRI of cervical spine ?

[Donald Corenman, MD, DC]

#9615

At this time, I do not look at images electronically as unfortunately, there are viruses attached to some of these files and the price to be paid in internet technologist times to rectify the damage is high. I do review mailed in DVD/CDs at this time for free but that will probably change in the near future as the amount of reviews I do have amplified to the point that I have no further time. Contact my office if you want me to review your studies.

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]

#9616

Thank you further Dr. Corenman and can certainly understand the time, cost and money. You already dedicate yourself HERE to answering questions, which is commendable in this day and age and spend more time answering questions here them most medical professionals we pay for medical evaluation…………you surely got your “calling” right♥

[justenough]

#9829

Dr. Corenman,

I got a 2nd over read of my cervical MRI that was read by the first RAD as normal / unremarkable and will post the 2nd over read now:

Impression:
1. Reversal of the upper cervical lordosis.
2. C3-4 level: Broad based disc bulge indents the anterior thecal sac eccentric to the right narrowing
the right lateral recess.
3. C4-5 level: Broad based disc herniation indents the anterior thecal sac. Posttraumatic etiology
cannot be excluded.
4. C5-6 level: Broad based disc herniation indents the anterior thecal sac narrowing the central spinal
canal and producing deformity of the anterior cord margin. Posttraumatic etiology cannot be
excluded.

I have not been back to the spine center since the spine center sent me to neurologist after because the 1rst read of cervical MRI was dictated as normal. I was sent for the MRI because the spine center said all extremities had hyper flexia …….and abnormal rhomberg / romberg

plus my own list of symptoms in hands feet ect…

So after seeing neurologist he did EMG on lower extremities and said abnormal….it shows evidence of L5-S1 problem and periphreal neuropathy ( tibial ) bilateral….that neurologist said my disequilibrim is because of nerve loss in feet and tibials …and symptoms in my hands and stuff are neck related……but I am concerned there is pressure on my spinal cord intermittently at times causing more symptoms and damage …I also read this ….

Pathoanatomic investigation of cervical spondylotic myelopathy.
Iwabuchi M, Kikuchi S, Sato K.
Source

Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Japan. [email protected]
Abstract

Multiple dural sac and spinal cord indentations are often observed on MRI in cervical spondylotic myelopathy. However, it is rare that all of the indented levels contribute to clinical symptoms. Pathological changes in cervical compression myelopathy have previously been reported. Still the critical degree of spinal cord compression needed to induce pathologic changes is unknown. To clearfy this matter the relationships between the spinal cord as well as the dural sac indentations, and pathological changes of the cervical spinal cord were investigated in cadavers. Sixty-eight cadavers were used for this study. The dural sac and the spinal cord were observed especially regarding presence of indentations. The spinal cord was removed from the specimens in order to perform histopathological examination. The indentations of the dural sac and the spinal cord were observed at C4/ 5, C5/6, C6/7 and C3/4 intervertebral levels in order of incidence. However, all of the dural sac indentations were not correlated with spinal cord indentations. Pathological changes in the spinal cord were observed in two specimens with less than 30% of the AP compression ratio. One specimen with 20.9% in the AP compression ratio had remarkable histopathological changes. In the other specimen with 29.6% in the AP compression ratio, diffuse demyelination was distributed in the lateral white matter. The results indicate that the critical degree of the AP compression ratio is 30% to induce histopathological changes in the spinal cord. If a spinal cord indentation in the patient with cervical spondylotic myelopathy on imaging, i.e. MRI, show less than 30% in the AP compression ratio, the clinical symptoms, i.e. numbness, tickling and paresthetic pain, may not be improved after the surgery because of some histopathological changes in the spinal cord.

( this study and result looks sort of contradictory, but all in all it is saying that less then 30 compression on spinal cord has shown pathollogical changes in spinal cord that are irreversable.

I need proper help I feel like I am going in circles and don’t know what to do…

[Donald Corenman, MD, DC]

#9832

It is almost the rule that when I see patients with “indentations” of the anterior cord without central stenosis, they will have absolutely no symptoms of myelopathy. Cord indentation can on a rare basis cause cord dysfunction but that is the exception-not the rule.

The EMG noting peripheral neuropathy is highly suspect for your symptoms. Hand symptoms could also originate from peripheral neuropathy as this is a fiber length dependant disorder. This means that when the symptoms of peripheral neuropathy (which start in the feet) ascend into the knee region, the hands will become affected. The nerves that go to the hands are about the same length as the nerves that descend into the knees.

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]

#9834

I am confused on central stenosis term….I have cervical spine stenosis, but that was not measured in ” mm ” nor graded ( as recent literature suggests ) grading stenosis now as grade 1, 2, 3 etcetera…….

I asked the one who performed the 2nd read to measure the stenosis with calipers, or however it is done, but I think he forgot….it was nice of him to give the 2nd read…..can i post a picture here of the region of stenosis ( its not that great of image to see the indentation on my spinal cord, but to measure the amount of stenosis could really be done, as you can also see in image I scanned I used the 10mm scale to try myself. Can you tell me if I can insert this image here….to see if if I measured correctly….please.

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