[JadedTinka]

#11897

I apologize, in my very first thread here I posted all of the information in one thread and was told how to post correctly, back pain in that section, neck pain, etc. so, I split them up, one for the lumbar spine, that you responded to, and this one, for the cervical spine, and put the MRI results for each in the appropriate thread. Thank you so much for your help!

[ebatts28]

#12146

Hello Dr. Coreneman,
As with most people on the forum, I am having the basically the same symptoms. I have numbness in my arms and hands, severe headaches and SEVERe body and facial and neck cramps. I have neck stiffness and pain. I had my MRI today and these are my results, could you please give me your opinion on the findings:

C5-6 demonstrates a Broad-Based Central Disk Bulge effacing the Sac and Abutting the Cord. No Cord Edema, The foramina are patent.

Mild Degenerative Changes.

Futher evaluation may require surgical consult.

Thank you for your opinion.

[Donald Corenman, MD, DC]

#12157

This MRI reading does not “paint a picture” of the compression of the cord. Effacement means “touching” and can include some mild compression but is not normally significant enough to cause symptoms of cord dysfunction (myelopathy-see website).

Cord abutment means some displacement of the cord but not compression of the cord. How “severe” is this abutment. Most radiologist will use mild moderate or severe to describe how sigificant the abutment is.

The other comment “Mild Degenerative Changes” means nothing without describing what levels are involved and what these degenerate changes are. I think it would be appropriate to ask for a reading by another radiologist in their practice to perform a free overread.

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.

[patrick01]

#12158

Hello Dr. Corenman
Please excuse the long post as this is my first time on your forum.

I have been treated by a pain specialist here in Albuquerque since 2006 with bilateral RF Ablasions, Epidural Steroid Injections, Cervical Medial branch Blocks and Intraarticular Facet Injections. This treatment was effective at first but the frequency of treatments has increased and the effectivness has decreased.

Current Medications are Hydrocodone 10-325, Metaxalone 800Mg, & Gabapinton 1800 Mg.

Physical therapy helped with ROM

I am post T11-T12 decompression with lamenectomy and Harrington Rods T9-L2 due to a motorcycle accident where I had a head on with a tree suffered a compression Fx.

This is the most recent MRI

INDICATION: 55 -year-old male with history of neck pain and cervical spondylolysis. Left upper extrerpity muscle
spasms with stabbing pain of the left scapula and electric sensation below the left chin extending to the left ear and scalp. Left arm perceived weakness, pain in neck when turn head left or lean head left. Constantly wake up at night due to discomfort.

~HNIQUE: Unenhanced MRI of the cervical spine.
I ..• DINGS: There is moderately severe multilevel degenerative disc disease of the cervical spine C3- 7 with multilevel
posterior bulging disc osteophyte complexes. No evidence of fracture or metastatic disease.
Cerebellar tonsils are normally located.
Multilevel acquired central canal stenosis without appreciable evidence of altered cord caliber or signal intensity on the
sagittal sequences.
C2-C3: Unremarkable.
C3-C4: Bulging disc osteophyte complex with bilateral uncovertebral hypertrophy. There is moderatel severe right and
mild left neuroforaminal narrowing present with right lateral recess effacement and mild superimposed acquired central
canal stenosis.
C4-C5: Bulging disc osteophyte complex with bilateral uncovertebral hypertrophy. Severe right and m~derately severe
left neuroforaminal narrowing greatest at the neuroforaminal entry zone. Mild to moderate superimposed acquired
central canal stenosis on the axial images.
C5-C6: Bulging disc osteophyte complex with bilateral uncovertebral hypertrophy. Moderately severe ilateral
neuroforaminal stenosis, right greater than left. Mild superimposed acquired central canal stenosis.
C6-C7: Eccentrically bulging disc osteophyte complex toward the left, with left lateral recess narrowin . Left greater
than right neuroforaminal entry zone narrowing. Mild superimposed acquired central canal stenosis.
C7-T1: Mild diffuse disc bulging. Mild bilateral neuroforaminal narrowing. No significant central canal tenosis.
IMPRESSION:
1. Multilevel degenerative disc disease of the cervical spine with multilevel acquired central canal stenosis and
neuroforaminal stenosis. Significant bilateral neuroforaminal stenosis is present. This is worse at the 4-C5 level
followed by the C5-C6 and C6-C7 levels.

My question is my Nuerosurgeon is suggesting a 4 level ACDF C3-C7 using Trabecular metal for the graft. Does this oppinion sound reasonable to you and also what is your oppinion of Trabecular metal?

Thank you Dr. Corenman
Patrick

[Donald Corenman, MD, DC]

#12163

Your pain sounds to be originating from degenerative cervical kyphosis with isolated disc resorption. See both topics on the website to see if this fits with your complaints.

You might be a candidate for a four level fusion but there are some confounding factors that might be important for you. How much motion do you have at these levels (found by measuring flexion and extension X-rays)? The less motion you have, the more effective the surgery and the less motion you will lose.

How much kyphosis do you have (measured by the neutral lateral X-ray. The more kyphosis (the opposite alignment from the normal lordosis) that you have, the more effective the surgery can be.

Can the C3-4 disc be spared (how degenerative is this disc)?

What is this surgeon’s experience in realigning the disc spaces back to at least neutral and hopefully to lordosis? The better return to neutral or lordosis, the more effective the surgery will be.

His or her use of “Trabecular metal” for the graft is not appropriate in my opinion. This is essentially a “spacer” and not biologically active. The hope is that the bone will grow into this metal and become stable. In my opinion, allograft (donor bone) is much more effective for fusion, will be less prone to subside (erode into the vertebral body) and be much more biocompatable.

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.

[patrick01]

#12175

I believe the spine is stable if i read this report correctly. The Surgeon suggested C3-4 as well because of a comparison to a 2012 MRI that has shown an apparent change to that level. He said it was best to take care of it now instead of going back in again in the future.
As far as the kyphosis goes I spoke to the Dr. about this and asked if it could be addressed at the time of the fusion to restore the normal Lordosis, he said that it wouldn’t be necessary. I told my wife that didn’t sound correct but I would get another opinion.
The Trebecular Metal was a new one for me as well! I had experiance with Iliac Crest graft for a prior fusion and had read about allograft but never Trebecular Metal.
I’m loosing confidence in my choice of a Surgeon so if you have any suggestions for a Dr. in Albuquerque area that would be great other wise I will make an appointment to visit your office.

Thanks

CERVICAL SPINE INCLUDING FLEXION/EXTENSION:
CLINICAL HISTORY: Cervical stenosis.
-CHNIQUE: X-rays of the cervical spine performed 01/12/15, there is a comparison MRI of the cervical spine report
from 12/23/14.
FINDINGS: There are moderately severe degenerative changes in the mid to lower cervical spine with multilevel
moderate disc space narrowings and anterior osteophytic spurring extending from C4 through T1 .
There are no compression fractures or prevertebral soft tissue swelling.
There is minimal fixed posterior subluxation of C3 upon C4, minimal fixed posterior subluxation of C4 upon C5 which are
likely degenerative disease related.
The C1-C2 relationship is normal.
There is mild reversal of the normal cervical lordosis.
The visualized lungs are normal.
IMPRESSION:
1. There are moderately severe multilevel degenerative changes at the mid to lower cervical spine with minimal subtle
posterior subluxations as detailed above.
2. Overall these findings are stable when compared to most recent MRI of the cervical spine from 12/23/14

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