[Sherrycox]

#27555

DR. Corenman,
I have had 2 mri’s, x-ray, and ct of my cervical spine. They showed sone Compression, bulging and 1 herniated disc from c3-6. Ther is also degeneration involved. I have loss of balance and my left hand goes numb when I turn my head to the left looking over my shoulder, usually takes only 30 seconds for my hand to start tingling. I was thrown forward onto the left side of my head, down and into the bed of a fire truck.
My questions are:
Can these neck problems cause loss of balance?
Would an “upright MRI” show more compression, more clearity, than the normal “position MRI”?
Thanks Dr. Corenman for this site.
I’m 53, female, volunteer fire & ems, working maintance for my local school. In March 2016 I was involved in a low speed fire truck accident while fighting a grass fire. I was ridding on the hose reel on a “brush” truck when we hit a road crossing in front of us, unseen because of high grass. We came to a sudden stop, I was thrown forward and down into the steel flat bed of the truck. I landed on my left side of my head. I had large bruises on the insides of my thighs from the metal ring that holds the hose on the reel, lost a shoe in the process of being thrown. I also had a second degree burn on my left hand after another incident on another fire truck that same day when I wasn’t seated and the driver started forward causing me to lose my balance and put my hand down onto the exhaust muffler on the water pump.. Not a good day for me! I had no neck pain, could have been dulled by the pain meds given for the burn. I slept in a ridged c-collar because it was the only way to get any rest.
Most recent MRI w/o contrast:

Details
Study Result
Impression
Impression: Multilevel degenerative intervertebral osteochondrosis
and facet arthropathy is noted as described. Findings are more
pronounced at the C4-C5, C5-C6 and C6-C7 levels. At the C5-C6 level
there has been some progression of the degenerative process. At the
C6-C7 level the findings have improved compared to the last
examination suggesting that there is some retraction of the disc
extrusion.
Narrative
Presbyterian

Clinical Indication: worsening of neck pain, headaches, and dizziness

MRI CERVICAL SPINE WITHOUT CONTRAST

Comparison study: MRI dated 6/29/2016 and x-rays dated March 26, 2016

Findings: The alignment and segmentation of the cervical spine are
normal. The cervical vertebral bodies show no sign of fracture or
destructive lesion.

The spinal cord shows normal shape and signal intensity on this
noncontrast exam.

The cranio-cervical junction anatomy is unremarkable.

There is multilevel degenerative intravertebral osteochondrosis and
associated facet arthropathy.

C1-C2 level: There is no significant abnormality associated with the
atlantoaxial joint.

C2-3: There is no significant extrusion or protrusion noted.

C3-4: There is a small central disc the protrusion noted resulting in
mild distress compression of the thecal sac. Mild progression of the
degenerative change is noted.

C4-5: There is mild spondylosis. There is a slight hypertrophy of the
uncovertebral processes. A small central disc bulge is noted.
Stability is a central disc protrusion present.

C5-6: There is loss of disc height and desiccation present. There is
hypertrophy and eversion of the uncovertebral processes associated
with anterior and posterior spondylosis. There is a broad-based disc
protrusion present.The spondylitic disc complex results in extrinsic
compression of the anterior aspect of the spinal cord. Findings have
advanced slightly since the last examination. There is mild facet
arthropathy.

C6-7: There is loss of disc height and desiccation present. There is
hypertrophy and eversion of the uncovertebral processes associated
with anterior and posterior spondylosis. Broad-based disc extrusion
is noted. There is extrinsic compression of the spinal cord centrally
and in the subarticular area. Mild facet arthropathy is seen. I
believe findings are less pronounced as there is less compression in
the left lateral aspect of the spinal cord compared to the last
examination

C7-T1: There is no significant extrusion or protrusion noted.

The visualized posterior fossa discloses no significant signal
alteration.

The paraspinal muscles are symmetric.
Component Results
There is no component information for this result.
General Information
Collected:
05/31/2017 1:10 PM
Resulted:
06/01/2017 8:19 AM

Brain MRI:
Study Result
Impression
IMPRESSION:

1. There is a very large retention cyst/polyp in the right maxillary
sinus, with additional mild scattered polypoid paranasal sinus
disease , as detailed above. Clinical correlation is advised in this
patient with a history of “headaches worsening after accident/MVA”.

If there is strong clinical concern to further evaluate the
paranasal sinuses for disease – a dedicated (outpatient elective) CT
of the Sinuses may be of further benefit.

2. Otherwise – there are NO ACUTE posttraumatic intracranial findings
– the remainder of the examination is unremarkable – there is NO
acute infarction, acute intracranial hemorrhage, intraparenchymal
masses, nor abnormal extra-axial fluid collections.

3. There are other minor chronic findings as detailed above.
Narrative
Clinical indication : H/o MVA, HA worsening started after
accident, Age > 50..chronic headaches worse after auto accident March
2016.

Comparisons: Head CT from 4/5/2016, MRI of the cervical spine report
from 5/31/2017

HMINWKS125

Exam: MRI BRAIN WITHOUT CONTRAST

Findings: The brain parenchyma demonstrates relatively normal
signal intensity.

The major arterial and venous flow voids appear normal.

The ventricles and sulci are normal in size and configuration for
the patient’s age .

The visualized internal auditory canals are unremarkable.

There is a very large retention cyst/polyp in the right maxillary
sinus, with additional scattered mild polypoid mucosal disease in the
maxillary sinuses and the right sphenoid sinus. There is minor
nasoseptal deviation convex right. There is no significant
opacification the mastoid air cells.

The visualized parotid glands are negative.
The visualized TMJs are located bilaterally.

The visualized globes and orbital contents are negative.

The cranio-cervical junction is normal.

There is straightening of the normal cervical lordosis, with mild
degenerative changes of the visualized upper cervical spine. These
findings were better seen on the dedicated MRI of the cervical spine
from 5/31/2017. Clinical correlation is advised.

The images are slightly compromised secondary to patient tilt /
positioning on the MRI scanner .
Component Results
There is no component information for this result.
General Information
Collected:
11/15/2017 8:33 AM
Resulted:
11/15/2017 11:50 AM
I have LOSS OF BALANCE as my main problem. The “drunk”heel to toe with head looking at my feet causes me to fall to both sides. Looking up, like putting eye drops in causes me to fall backwards. Turning my neck totally left looking over my shoulder causes my left hand to go numb. I have stress headaches when I sit in a straight back chair for meetings, and when my neck is put under stress by lifting or when I’m bent over working on something. I’ve had RFA C2-6 left and right, helped headaches for 2 weeks. I have no neck pain, I stopped going to the chiropractor because after last cervical manipulation the loss of balance was worse.

I have seen 3 neurosurgeons who say my Loss of Balance has nothing to do with my neck. Was sent to neurologist that did brain MRI.
Can you please give me your opinion, and suggestions.
Thank you
Sherry

[Sherrycox]

#27575

I have had vertigo testing by neurologist, it was negative. I’ve also had RFA C2-C6 by pain specialist, helped headaches for about 2 weeks. I am pretty much ” off balance” all the time, except while sitting.

[Donald Corenman, MD, DC]

#27596

You have many questions and I will try to answer what I can. Balance is a complex neurological process that can be affected by the cervical spine but not commonly. The two disorders that can occur are myelopathy due to cord compression (due to cervical stenosis-see https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/). The other disorder is even more unusual-vertebral artery syndrome where the artery becomes compressed due to instability or spur.

You do have some stenosis of the cervical spine at C6-7 but there is no description of the severity (“There is extrinsic compression of the spinal cord centrally and in the subarticular area”) so there is no ability to understand how significant the compression is. The physical examination goes hand-in-hand with myelopathy (long tract signs) so these signs need to be present.

I would think that sinus polyps would not cause balance problems but I have no experience with treating these polyps.

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.

[Sherrycox]

#27635

Thanks for the reply, would making an appointment with you have benefits. I live in New Mexico, but if having a hands on, you reading my, Ct, MRI, etc results would help me get answers, I would be open to the 7.5 he drive to see you. Thank you, Dr Corenman
Sherry

[Donald Corenman, MD, DC]

#27636

I would be happy to see you> i do have many patients from Taos, Santa Fe and Albuquerque so you would not be alone. However, I have a program called a a long-distance consultation where you send all your images, previous consultations and fill out all my new patient paperwork. I then review all your information and have a 20-30 minute interview over the phone with you.

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.

[Sherrycox]

#27639

I need to clear something up. I experience loss of balance. Lots of the references in the test results say “dizziness”, To me there is a big difference.
I have a volunteer fighfighters insurance and if I can get them to do an appointment I will. I have an appt for ENT Thursday to see if the sinus cyst is the cause of my Loss of balance, then I see PT ON the 28th to see what my level of disability is as to balance. So far we have struck out on getting any answers.
Thank you, again!
Sherry

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