[riclach]

#28129

Hello Dr. Corenman:

This is my latest MRI report – from last week

OSSEOUS STRUCTURES: Levoncovex cervical curve with a Cobb angle measuring less than 10 degrees. No spondylolisthesis. No bone marrow edema. The cervical spinal canal is congenitally narrow due to short pedicles

FACET JOINTS: Scattered mild and mild to moderate facet arthropathy

C2-C3: Normal disc. No spinal stenosis or neural compression

C3-C4 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 9.5 mm. Uncovertebral hypertrophy contributes to moderate to severe right and mild left neurforaminal narrowing

C4-C5 Small to moderate sized diffuse disc osteophyte complex contacts and moderately contours the ventral spinal cord and causes moderate narrowing of the central spinal canal with an AP sac diameter of 7.5 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing.

C5-C6 Small diffuse disc osteophyte complex contacts and mildly to moderately contours the central spinal cord and causes moderate to severe central canal stenosis with an AP sac diameter of 7 mm. Unconvertebral hypertrophy contributes to severe right and moderate to severe left neuroforaminal narrowing

C6-C7 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 10.4 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing

CORD/DURAL SAC: Normal

PARASPINOUS SOFT TISSUES: Normal

IMPRESSION:

1.Multilevel spondylotic changes of the cervical spine
2.Multilevel severe and moderate to severe neuroforaminal narrowing
3.Moderate to severe central canal stenosis at C5-C6

*** THIS IS THE REPORT FROM THE MRI I HAD IN DECEMBER 2016 –

FINDINGS: AP alignment is near anatomic. Vertebral body heights are normal. No worrisome bone marrow signal. No high-grade space narrowing. No abnormal signal involving the spinal cord. No paravertebral soft tissue abnormalities.

C2-C3 There is no spinal canal or neural foraminal stenosis

C3-C4 There is no spinal canal stenosis. Right uncovertebral hypertrophy with minimal right and no significant left neural foraminal narrowing

C4-C5 There is a small posterior osteophyte with minimal ventral thecal sac indentation. The spinal canal is minimally narrowed. Bilateral uncovertebral hypertrophy without significant neural foraminal stenosis

C5-C6 There is small disk osteophyte complex and mild ligamentum flavum thickening with mild spinal canal narrowing. Bilateral uncovertebral hypertrophy with mild neural foraminal narrowing bilaterally

C6-C7 There is no spinal canal stenosis. Left greater than right uncovertebral hypertrophy with mild to moderate left and no significant right neural foraminal narrowing

C7-T1 There is no spinal canal stenosis. No neural foraminal stenosis

IMPRESSION:
1.Mild cervical spondylosis with mild C5-C6 and minimal C4-C5 spinal canal narrowing. The spinal canal is congenitally slender
2.Multilevel low-grade neural foraminal narrowing described level by level above

Commen – When compared to the October 2014 examination, there is no significant interval change

*** THIS IS THE REPORT FROM THE MRI I HAD IN OCTOBER 2014 –

C1-C2 Mild degenerative changes present.

C2-C3 No significant central canal or neural foramina stenosis

C3-C4 Right greater than left uncovertebral hypertrophy resulting in mild right neural foramina stenosis.

C4-C5 Diffuse disk bulge and bilateral uncovertebral hypertrophy. These result in mild bilateral neural foraminal stenosis. The ventral thecal sac is effaced and there is minimal cord contact. No cord edema or myelomalacia. No cord deformity.

C5-C6 Bilateral uncovertebral hypertrophy in addition to a diffuse disk bulge. There is moderate bilateral neural foraminal stenosis and effacement of the ventral thecal sac with probable cord contact. No evidence of abnormal cord signal. No cord deformity.

C6-C7 Bilateral uncovertebral hypertrophy resulting in moderate left and mild right neural foramina stenosis. There is minimal effacement of the ventral theca sac by a diffuse disk bulge without cord contact.

C7-T1 No significant central canal or neural foramina stenosis.

Impression: 1. Multilevel degenerative disk disease with disk bulges resulting in cord contact at C4-C5 and C5-C6. No significant cord deformity or abnormal cord signal intensity. 2. Low-to-intermediate grade multilevel neural foraminal stenoses are present bilaterally.

***************************************************

I have radicular pain that refers down to my right fingers since 2014.
I also have right shoulder and arm pain, migraines and occipital headaches (which were helped with an occipital injection)
I have noticed that my right grip is weaker than me left even though I am right handed.
I have problems opening jars and experience weakness in my right arm and hand.
I cannot sleep on my right side because it increases the pain in my right shoulder.

I have limited neck range of movement.
Moving my neck to the right and left hurts as well as flexing it and extending it.
For instance, when I read, the reading material needs to be at eye-level or my neck will hurt. This prevents me from doing many activities.
I had facet joint injections that helped with the above symptoms tremendously for 6 weeks, then I hurt my neck by working in the yard and extending it for too long and the pain came back.
Since the facet injections worked so well, I had the radiofrequency ablation.
The procedure did not help my facet joint pain but it did help with the radicular pain for about 10 days. It actually feels like it made my facet joint pain worse.
It’s now been 9 weeks since the procedure and I am still getting shooting pains like electric shocks in my neck.
I made an appointment to see a surgeon but my appointment is not until 2 months from now.

I understand that the ACDF surgery can help the radicular and arm pain.
But can it help the facet joint pain that I described?

In your opinion do I need the ACDF surgery?

Thank you so much!!!!!

Claudia

[Donald Corenman, MD, DC]

#28137

You have multiple problems in your neck so we will need to go level by level. First, see this section to understand what symptoms each individual nerve root would generate: https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ I’ll indicate the nerve possibly involved at each level. In addition, you have spinal stenosis which could cause spinal cord compression and myelopathy. See this section to understand myelopathy symptoms: https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/

“C3-C4 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 9.5 mm. Uncovertebral hypertrophy contributes to moderate to severe right and mild left neurforaminal narrowing”. Spinal canal here is mildly tight but probably not a big current problem. The nerve roots here are compressed. Look for symptoms especially of the right C4 nerve root.

“C4-C5 Small to moderate sized diffuse disc osteophyte complex contacts and moderately contours the ventral spinal cord and causes moderate narrowing of the central spinal canal with an AP sac diameter of 7.5 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing”. Here the spinal canal is quite narrowed and myelopathy could be a problem. Also, both right and left C5 nerve are compressed.

What is concerning is that your report from 2016 does not note the significant cord or root compression that is present on your current report (old report:”C4-C5 There is a small posterior osteophyte with minimal ventral thecal sac indentation. The spinal canal is minimally narrowed. Bilateral uncovertebral hypertrophy without significant neural foraminal stenosis”). Here there is no cord compression or root compression noted here. Did you have significant progression in 1-2 years or is this a different radiologist who missed the compression? One man’s mild is another man’s moderate to severe. This is why I hate looking at images through someone else’s eyes.

“C5-C6 Small diffuse disc osteophyte complex contacts and mildly to moderately contours the central spinal cord and causes moderate to severe central canal stenosis with an AP sac diameter of 7 mm. Unconvertebral hypertrophy contributes to severe right and moderate to severe left neuroforaminal narrowing”. Here you have C6 nerve compression bilaterally and cord compression too. Look for C6 nerve involvement and myelopathy.

C6-7 and C7-T1 are not really problematic based upon the report.

Your symptoms could be from C6 nerve involvement as the C5 nerve does not radiate into your hand but does involve the shoulder. Your hand weakness can be generated from the C6 nerve compression or from myelopathy.

If there are discrete findings of facet joint arthritis that can be proved (by facet joint injections) with great temporary relief (see https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/), then a fusion of the degenerative level (ACDF) will relieve pain.

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.

[riclach]

#28139

“What is concerning is that your report from 2016 does not note the significant cord or root compression that is present on your current report …Did you have significant progression in 1-2 years or is this a different radiologist who missed the compression?”

Last summer (2017) I walked into a horizontal metal pole and knocked my head back pretty hard. Could that have caused more damage?

Thank you!!!

Claudia

[Donald Corenman, MD, DC]

#28143

Possibly.

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.

[riclach]

#28237

Hello Dr. Corenman:

I mentioned that “I cannot sleep on my right side because it increases the pain in my right shoulder.”
The pain when sleeping is in my scapula region.
I understand that cervical radiculopathy can affect the shoulders and I do have pain in my shoulder region at other times also.
I’m trying to figure out if the pain I feel when lying on my right shoulder is coming from the neck or if it’s caused by a shoulder problem. I read your article -https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/
I don’t have pain when raising my arm or when “reaching the arm behind to put on a coat or even driving by holding the upper part of the steering wheel”.
But I did notice that a couple of nights ago I woke up with intense shoulder pain while sleeping on my back with my right arm bent back under the pillow. I usually don’t sleep with my arm under the pillow.

My question is – can cervical radiculopathy and degeneration cause pain in the shoulder when lying on it?
Is that a common complaint? Or is that more common among people with actual shoulder problems?

Thank you so very much!!!

By the way, I use 2 body pillows to support each side of my body when I sleep on my side. I have a cervical pillow and I believe my spine is in good alignment.

[Donald Corenman, MD, DC]

#28238

Scapular pain is commonly generated by cervical nerve root compression. Sleeping can allow your head to tilt backwards or lean to the right side which causes increased foraminal stenosis and root compression. This can cause scapular pain. Also, impingement syndrome of the shoulder can do the same thing. You need a careful examination and diagnostic injections to determine the source of your pain.

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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