[Donald Corenman, MD, DC]

#9835

Central stenosis generally causes myelopathy due to compressive injury to the cord. This occurs due to central stenosis where the cord has no CSF “padding” to protect it. The canal changes in diameter with flexion vs. extension. Extension narrows the canals diameter.

Myelopathy occurs when the canal is too narrow and the maneuver of extension “bangs and dings” the cord. Eventually, the cord malfunctions and cannot transmit signals back and forth to the brain. This is the essence 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]

#9837

That is my confusion then…Central stenosis VS cervical stenosis, since both can cause myelopathy.

When there is no CSF in the C5- C6 anterior aspect of the spinal CANAL because a disc has herniated and compresses the spinal cord ( creating an indention in the spinal cord itself …..in conjunction with 2 areas of buckling or hypertrophy of the ligamentum flavum ( posterior to the C5-C6 disc herniation ) can that cause myelopathy, with flexion or extension given the there is no telling how much dinging is going on ( walking, bending, driving, laying, turning over in bed and lying on side in bed )

A still image ( ie ) MRI of cervical spine laying down shows the anterior aspect of spinal CORD is indented at the C5-6 region with NO CSF obviously since the disc is pushed into the spinal cord, and in addition at same region, but posterior to the C5-6 which further narrows the spinal canal ( cervical stenosis) is the buckling or hypertrophy of the ligamentum flavum, and there is CSF present in the posterior section as described, just not the anterior portion, which again is because the disc has pressed into the spinal cord….

I hope I am explaining this right…..there is no increased signal in the spinal cord ( which represents permanent damage to the spinal cord )

But my concern, and because of my symptoms that do indicate myelopthy, IF there is too much pressure on the cord, whether medical science feels the cord has to be squashed significantly before there can possibly be myelopathy……….due to my hands upper wrist, feet, chins…. disequilibrium, severe ear ringing and such….

of which are really bothersome for me, in addition the spine clinic evaluation that noted hyerflexia in all extermities, but then subsequent to the spine clinic reflex test, the neurology Doctor repeated test and said my reflexes in legs were 1+ otherwise absent, he also later did the EMG which was abnormal and said mild to moderate periphreal neuropathy as well as some portion of the EMG was indicative of L5- S1 ( but have had NO MRI of lumbar spine )

I am 5’3 1/2 109 lbs on a good day……I am not diabetic……so I am so confused :(

I just want to find a root cause and treat if I could get better :(

[Donald Corenman, MD, DC]

#9841

The cord can dysfunction with an anterior herniation or spur that compresses the anterior cord but that scenario is typically found with a kyphotic deformity of the neck. The neck normally is in lordosis, a backwards “C” curve and the cord floats in the center of the canal. Kyphosis is a reversal of the normal lordosis and allows the spinal cord to be draped over the front of the neck.

In cases of severe degenerative changes or old trauma, the disc can degenerate causing a spur that juts into the canal and a reversal (kyphosis) of the normal curve. The supraspinous and interspinous ligaments (ligaments in between the spinous processes that prevent kyphosis from occurring) can be injured in a fall with head impact. This ligament injury can have occurred even many years earlier and allow a gradual increase of this abnormal curve.

With a significant kyphosis and a spur or herniation, the cord drapes over this abutment and the chronic pressure causes cord dysfunction or myelopathy.

However, the typical disc bulge, herniation or spur will not cause cord dysfunction if the canal is open behind the cord (evidenced on the MRI by CSF found behind the cord).

Myelopathy will demonstrate on physical examination, long tract signs (see myelopathy on the website). Peripheral neuropathy will demonstrate very different signs on physical examination. The symptoms of peripheral neuropathy however can be very similar to myelopathy so the physical examination is very important.

Neuropathy has many causes and only one is diabetes.

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]

#9843

Thank you for articulating all that into a way to answer my further questions. I have so much going on from head to toe ( literally ) I just was praying there was one common factor contributing to all of it ( my neck ) and it is just not to be.

I just don’t see how the spine center reflex exam said hyperflexia in all extremities.

Then a week later the neurologist reflex exam only mentioned hypoflexia in legs, no mention of upper extremity abnormality.

Then the EMG shows periphreal neuropathy and L5-S1 abnormality.

My abnormal romberg, worse with movement or static standing, eyes closed or dim lighting ( my own description )and swaying even when sitting, literally rocking at times uncontrollable.

CRAZY ear ringing and other noises, swooshing at times, sometimes feeling like 2 plungers on both ears, but subsides, squeaking, spongy sounds, amongst the cracking in jaw joints

and prior to the neck MRI, I was already diagnosed through MRI and Cone beam CT scan, bilateral TMJ dysfunction, severe and causing arthritis in jaw joint ( my jaw is called a permanent closed lock ) So that could explain some……….

I just have so many symptoms going on at once, if I could get a grip or find one common denominator and fix it, but there is too much and don’t know what to do except cry out of pain, frustration and going from a person who was so active all my life, 2 careers and the last 10 years working 2 jobs at once by choice ( I loved my medical career and my specialty )

To not being able to work at all……..to being home bound most of the time…..because of my many symptoms that travel up and down day and night, some worse at times then others, and then if one thing slacks off, another rears its ugly head…..

I have never taken a pain medication other then ADVIL or Alieve, I despise pharmaceutical drugs……they mask symptoms………they are only pallative care and cause a host of other problems…….

I guess I will see where all this goes and either spend the rest of my life suffering waiting to die or die early from suffering.

My sister, 2 years older then me has Sjornes ….and I am being tested for that eventually by the neuro, but he really wants me to accept his other diagnosis of migraine varients and take medication for that….

I just want to conquer all of it on my own………and be the me I WAS….work, live……….this is not living the way I am….I do not have paralysis, am not on a ventilator, have all my limbs, but nothing is working as it should and its overwhelming to me.

I have just had enough the last 4 years………when i finally pass out after laying down ( laying down causes a host of other issues with my neck ( I was also diagnosed with cervical dystonia ) my neck sits to right, shoulder scapula droops 2 inches below left )

I have shaking in hands, they are clumsy, 4 years ago at start felt like I was walking like a duck, legs further apart then normal….I wish someone could step into my body one day and feel all I feel….even though I look pretty normal on the outside.

I watch older people, and see them with different difficulties and wonder if they feel like I do all over and if they do, how they deal with it so long…………

I am crushed!! And I pray to GOD continuously to give me more strength and forgive me for complaining when others have it worse.

Thank you for answering my crazy 100 questions, I feel my symptoms are making me crazy….:(

[Donald Corenman, MD, DC]

#9851

Your symptoms are certainly varied and seem to have many different causes. I would be frustrated too.

Don’t discount medications. Even if these medications are strictly palliative, they still can do some good. If you know what is causing your pain and there is no real solution, then reducing your pain with medications is acceptable and can improve the quality of your life.

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]

#11491

I wrote to you on your message board here last year and you said to have beginning symptoms of myelopathy there need not be hyperintense signal with spinal cord…….my symptoms are severe disequilibrium – pins and needles in feet sometimes extending into chins and hands as well- coordination issues with hands doing intricate things – like picking up change, keys etcetera- also when standing or using my arms, my arms feel electricity and get icy cold- I have no balance in the dark, taking a shower is nightmare…and standing still in one spot I am swaying and rocking, gripping toes to the ground to keep my balance ..i am so misreable – there is more , and whats odd is my last MRI before this one showed the C5-6 disc actually slightly indenting the spinal cord and in this more recent MRI of my neck- I do not see the disc actually touching, yet the spinal cord is more pushed in now then it was last year …can my neck be causing all my symptoms please…..I am begging for help and not getting any here where I live….I value your opinion, you took more time online with me then any doctor I ever paid in person.

Also the most recent images I sent to your info page email were taken supine laying on back…..and when I stand my xrays show reversal of the cervical spine….. …so I do wonder if when standing ( dependent on your experience in how the neck reversal goes and increases or decreases spinal cord with a reverse cervical spine on standing, if that would cause the spinal cord to have more of a compression ) and maybe I need a cervical spine MRI in standing, with flex and extension?

The images I sent have a subject header with my user name here so hopefully you will be able to compare the images to my message here….thank you again for your helping so many people……there are too few of people like you left in this world …TRULY appreciative !

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