Tagged: long distance consultation
exspineParticipantSeptember 12, 2018 at 3:15 amPost count: 3
Dear Dr. Corenman,
Three months ago I made an MRI of my cervical and lumbar spine, and the reason being that I knew that I had a small disc herniation at C5/6 (asymptomatic) and that I occasionally did get a ‘thrown back’, symptoms of which lasted for couple of weeks once and usually cleared within few days with every episode. I was mostly active and asymptomatic (running total of 8K five days before the MRI). When I say mostly asymptomatic, I did tend to get pins and needles in my hand, and some pins and needles in my pinky toe when flexing the foot inside.
To my great surprise these were the results of the MRI:
– Straightened lordosis of cervical spine
– Initial spondyloarthritic changes in small intervertebral joints
– Disc degeneration C4/5, C5/6 and C6/7
– Compressive disc osteophyte complex c3/4 and c4/5 dorsomedial and right compressing thecal sac and medula spinalis but without myelopathy. Also compressing radixes bilaterally
– Also herniated discs C5/6 and C6/7 dorsomedial bilateral, with compression on radixes bilaterally, thecal sac and medula spinalis without myelopathy
– No foraminal stenosis
– No cervical stenosis
– Stenosis of vertebral canal at L3/4, L4/5 and L5/S1
– Disc degeneration at L3/4, L4/5 and L5/S1 with Modic2 type changes
– L3/4 herniated disc with annular tear without compression
– L4/5 herniated disc with annular tear compressing radixes bilaterally and branches of cauda equina
– L5/S1 disc extrusion to the right with annular rupture. Herniated disc compressing radixes bilaterally and branches of cauda equina
I have been explained that this is a very bad MRI finding, and that I need surgery even though my sypmtoms are mild to moderate. I did develop some additional symptoms in last three months and to recap:
– Very mild neck pain on the left side when performing Spurling manoeuvre
– Occasional mild tingling in fingers
– My hands do tend to get numb while I sleep but moving the position helps
– When bending left elbow suddenly I do tend to get mild electrical sensation
– No motor weakness
– Couple of weeks I got thrown back and could not get out of the bed for a day, but eventually recuperated and now only have very mild buttock pain that seems to be diminishing by the day, albeit slowly
– There is a patch of skin on my heel that went almost numb to sensation, but seems to get better
– I perform heel and toe walk without problems
I have been told by one neurosurgeon that I need an immediate surgery, but have been advised by second and thrid not to do it, since I have no symptoms.
My question is, how could I end up in a situation like this without knowing about it?
What could be the cause, since I am athletic, 6 foot tall and 190 lbs and been doing recreational sports almost my entire life?
How can I prevent further deterioration of my spine?
What are the chances of my rehabilitation, could I be able to run, hike, ski, drive a bicycle?
I know this is too much to ask, but I would just like your opinion about the matter.
Thanks.exspineParticipantSeptember 13, 2018 at 3:05 amPost count: 3
I have just now realised that I failed to mention some symptom specifics:
– Shock like sensation in the hand when bending the elbow is in mostly in the pinky finger
– Mild buttock pain I am referring happens when I bend forward and in the right leg
– Loss of sensation on the heel is on the right side, and is diminishing by the dayDonald Corenman, MD, DCModeratorSeptember 15, 2018 at 2:02 pmPost count: 6438
You don’t have to jump into surgery if you have no myelopathy (spinal cord dysfunction) or motor weakness. You have a genetic predisposition to degenerative disc changes. There is probably nothing in particular that you did to cause this but running increases wear on the discs and if you could find another exercise (cycling, swimming, hiking) that could reduce or eliminate your running, the advancing degeneration changes would be reduced.
Your complaints of “Shock like sensation in the hand when bending the elbow is in mostly in the pinky finger” and “When bending left elbow suddenly I do tend to get mild electrical sensation” is probably from ulnar nerve compression. See https://neckandback.com/conditions/cubital-tunnel-syndrome/.
Your findings of “L5/S1 disc extrusion to the right with annular rupture. Herniated disc compressing radixes bilaterally and branches of cauda equina” is probably causing your “Mild buttock pain I am referring happens when I bend forward and in the right leg”. As long as you don’t have problems with strength in your calf muscles (tip toeing), you probably are OK. See https://neckandback.com/conditions/home-testing-for-leg-weakness/
Dr. CorenmanIf this forum has helped you, please let Dr. Corenman know!exspineParticipantSeptember 16, 2018 at 12:26 amPost count: 3
Thank you very much Dr. Corenman.
Is there any way for me to have you review the MRI images and provide a consultation for people living overseas?
I would like you to take another look at my images and give me the impression along with a brief discussion on the symptoms.
BestDonald Corenman, MD, DCModeratorSeptember 20, 2018 at 8:57 amPost count: 6438
I have a program called a “long distance consult” in which I review all the films you send to me as well as my new patient intake form you fill out and call you for an over the phone consultation which can last from 20-40 minutes. I make suggestions and follow-up calls are included. You can contact Lori, my office manager at the number at the top of the page for further information.
Dr. CorenmanIf this forum has helped you, please let Dr. Corenman know!
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