[JOLENE]

#31819

My symptoms are lengthy, and not entirely sure which, if any, can be attributed to the back and which can be attributed to the brain. They include moderate back pain, including shooting pains down the back of my legs, pain that radiates through my right should and arm, and weakness on my right side significantly, with mild weakness on the left, and a steady, nearly constant headache for the last 2 years. I have bladder and bowel issues, as well as sensory issues (strange feelings on my skin etc), as well as some neurological symptoms that are clearly unrelated to my back. Recently I began to experience severe neck pain. I had the MRI approx 11 months ago, but did not receive the report until yesterday, and I am not sure what it means at all. I had been previously advised that my issues were due to stress, but this seems to indicate otherwise. I had previous MRI’s in 2018 which showed lesions in my brain, but my MRI was limited to only my brain that time. My most recent (Jan 2019) MRI reads as follows (cut down to the relevant points regarding my spine, and final impression):

Cervical Spine:
The cervical spinal cord is normal in signal and caliber with no convincing focal lesions appreciated.
There is mild disc desiccation throughout the cervical spine, without significant disc herniation or spinal canal compromise. No significant neuroforaminal compromise.
Thoracic Spine:
The thoracic spinal cord is normal in signal and caliber with no convincing focal lesions appreciated.

Magnetic Resonance Imagine
Intervertebral disc space heights are fairly well-maintained. There are multiple small posterior disc herniations involving the midthoracic spine most prominent at t5-t6 where there is effacement of the anterior CSF space and mild flattening of the anterior spinal cord. The bilateral neuroforamina are patent at this level. Smaller disc bulges are noted at t4-t5 and t6-t7 without significant spinal canal compromise.

Impression:
No adverse interval change. Stable 3 white matter high T2/Flair lesions within the left external capsule, genu of the corpus callosum and inferior left cerebellar hemisphere. No new brain lesions, and no lesions identified within the cervical or thoracic spinal cord. Again these lesions remain nonspecific and may represent mild early demyelinating disease. These lesions would satisfy the revised 2017 McDonald criteria for dissemination in space in the appropriate clinical context. Neurology consultation is advised.

I thank you for any light you could shed on this for me.
Regards,
Jolene

[Donald Corenman, MD, DC]

#31824

You note “moderate back pain, including shooting pains down the back of my legs, pain that radiates through my right should and arm, and weakness on my right side significantly, with mild weakness on the left, and a steady, nearly constant headache for the last 2 years.”

You also note “I have bladder and bowel issues, as well as sensory issues (strange feelings on my skin etc), as well as some neurological symptoms that are clearly unrelated to my back”.

Your MRI is relatively clean “cervical spinal cord is normal in signal and caliber with no convincing focal lesions” and even your thoracic spine has changes that are not severe enough to account for your symptoms, especially above the mid-back “pain that radiates through my right should and arm, and weakness on my right side”.

However, your brain has some changes that could be consistent with MS or vascular type lesions (“Stable 3 white matter high T2/Flair lesions within the left external capsule, genu of the corpus callosum and inferior left cerebellar hemisphere”. You need a good neurologist to give you a complete detailed examination and possibly a collection of CSF to determine what your disorder could be. These symptoms don’t match the findings on the spinal MRIs.

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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