GlowParticipantNovember 1, 2020 at 2:25 amPost count: 3
Hi Dr Corenman,
I am wondering if surgery is the only answer for my problem. I started having mild pain and tingling in my left arm in April. In July, it became much worse and I went to my GP. He ordered an x-ray and gave me two weeks of prednisone and a week of flexeril. This did not help my symptoms, so we proceeded with an MRI. Here are the results of the MRI:
Narrative and Impression
MRI Cervical Spine without contrast
Image quality: Diagnostic
Alignment Straightening of normal cervical lordosis. No fracture or subluxation.
Marrow signal: Normal marrow signal is identified within the visualized bony structures No discrete marrow lesion.
CERVICAL AND VISUALIZED THORACIC Cord is compressed at several levels notably C5-C6 and C6-C7 Cord edema/gliosis present at the C-6 level.
Prevetebral and Paraspinal Soft Tissues: Normal
Visualized Posterior Fossa: The visualized Posterior Fossa demonstrates no abnormal signal.
NARRATIVE AND IMPRESSION
Cervical Disc Spaces:
C2-C3: Bilateral facet arthrosis, small right posterolateral disc osteophyte without significant stenosis.
C3-C4: Decreased disc height marginal osteophytes with small central protrusion. The cord is slightly flattened, AP dimension of the sac reduced to 5-6mm.
C4-C5;. Circumferential bulging of the disc broad-based left posterolateral disc osteophyte. AP dimension of the sac reduced centrally to approximately 6-7mm. Minor flattening of the cord, foramen are patent.
C5-C6:. Circumferential bulging of the disc extending asymmetrically to the left, AP dimension of the sac reduced to 4-5mm. Right greater than left facet arthrosis, foramen patent
C6-C7:. Broad-based posterior protrusion present. AP dimension the sac 3-4mm. Disc extends asymmetrically to the left. Correlate for myelopathy and left C7 radiculitis.
C7-T1:. Minor bulge, no critical stenosis.
Upper thoracic disc space: Normal
Multifocal spondylosis and osteoarthritis with cord compression present to varying degrees from the C3-C4 to the C6-7 level inclusive. Most severe stenosis at C6-C7, 3-4mm, where broad-based left posterolateral protrusion is present. Correlate for myelopathy and left C7 radiculitis.
Cord edema/gliosi C-6 level
When the MRI was ordered, I was put on Gabapentin 3 times a day. After the MRI results came back, my GP said to see a neurosurgeon and if surgery was suggested, I should get a second opinion. Surgery was suggested as one option and the other option was to try ESI and physical therapy. I had one ESi with no relief and I went to physical therapy and after her assessment, she said I needed to go back to the neurosurgeon. I called the neurosurgeon office and had my follow up appointment moved up to November 10. Do you have any recommendations for me? Please help as time is very short for me to make a decision.
Thank you for your time.
GloriaDonald Corenman, MD, DCModeratorNovember 1, 2020 at 9:11 amPost count: 8465
You note; “I started having mild pain and tingling in my left arm in April. In July, it became much worse”. I’m not sure what “worse” means (pain, increased pins and needles, weakness??) but I’ll continue.
Your imaging findings are significant; “Multifocal spondylosis and osteoarthritis with cord compression present to varying degrees from the C3-C4 to the C6-7 level inclusive. Most severe stenosis at C6-C7, 3-4mm, where broad-based left posterolateral protrusion is present….Cord edema/gliosis C-6 level”.
This means that your central canal where the spinal cord occupies this space is very narrowed. Normally the canal minimal diameter is 14mm and yours is 3-4mm, very narrowed with indication of cord injury “edema/gliosis C-6 level”. This will cause myelopathy. See this section https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
Your symptoms which initially drove you to the doctor (left arm symptoms) are most likely generated from the compression of the C7 nerve root at the C6-7 level (“broad-based left posterolateral protrusion”) causing foraminal stenosis. See this section https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/
In my opinion, you need surgery sooner than later.
Dr. CorenmanGlowParticipantNovember 1, 2020 at 9:23 amPost count: 3
When I say it became worse in July, ran the pain and tingling were worse in intensity and almost constant. Prior to July, I had mild pain and mild tingling that would only happen intermittently.
Also, since I have seen the physical therapist, the pain has become unbearable.
I get very little relief. I called pain management and they increased the gabapentin from 100 mg 3 times a day to 300 mg 3 times a day.
I would like to thank you very much for your feedback and I will be scheduling surgery when I see the neurosurgeon November 10. The neurosurgeon didn’t know what type of surgery could be done and sent me for a flexion extension x-ray. He said it would either be disc replacement or ACDF. The only thing on my flexion extension x-ray is retrolisthesis at C5 + C-. I’m hoping for disc replacement but I won’t find out until November 10. Any other opinion on this would be greatly appreciated.
Thank you again.
GloriaDonald Corenman, MD, DCModeratorNovember 2, 2020 at 5:30 amPost count: 8465
For a level of central stenosis, I recommend against an artificial disc replacement and advocate for an ACDF.
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