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  • kala9333
    Post count: 2

    I am in a world of pain and trying to find someone to help me understand exactly what is happening to me now. I have had back pain for many years and recently found out I am HLA B-27 positive which seems to be some of the reason for some of the lower back problems. In addition I have several autoimmune problems. I had an injury a year ago to my neck causing C3-4 central disc bulging & ventral flattening of the thecal sac. C4-5 broad based disc bulging, causing ventral flattening of the thecal sac and CSF sround the spinal cord and in the nerve root sleeves. C5-6 there is a central disc bulging, causing ventral flattening of the thecal sac. No central or forminal stenosis. C6-7 There is a focal right paracantral disc herniation, causing ventral flattenig of the thecal sac, compromising the right foramen, and flattening te right side of the spinal cord. There is still a small amount of CFS around the cord dorsally and in the left nerved root sleeve, but the right nerve root sleeve is shortened.
    I have very little information as to what this all means, but I am in alot of pain with grinding and popping when I move my neck. I have pain and weakness in my right shoulder, arm and hand, numbness etc. in fingers. The injury also caused atipical trigeminal neuralgia for which I was prescribed tegretol, but my primary physician screams because he says tegretol destroys bone marrow and it doesn’t seem too effective because the pain gets terrible. I am also having daily migrane type headaches. Ears are ringing and some visual disturbances The doctors wanted to do surgery for the C6-7 disc but are unable to operate due to an elevated white count possibly caused by one or all of the autoimmune problems I have had for years. Epidural steroids have been ruled out because I am not a good candidate due to reactions to steroidal injections in the past. I would appreciate any information You could give me to help me. I can’t get ant one to take the time to sit down and break down what it all means and there doesn’t seem to be any option for me at this time.

    Donald Corenman, MD, DC
    Post count: 8660

    You have a number of problems going on at once. Let’s break them down to simpler elements to allow some basic understanding.

    The HLA B-27 is a genetic marker that makes you more susceptible to autoimmune phenomenon that can affect the musculoskeletal system. That is, you might have your own immune system attack your spine causing pain, stiffness and aching. Have you been diagnosed with a disorder called Ankylosing Spondylitis?

    The pain in your neck and right shoulder/arm/hand more likely than not is not related to an autoimmune phenomenon. You have a disc herniation at C6-7 that is compressing the right C7 nerve root. This can cause neck pain that radiates into the shoulder, arm and hand, especially into the middle fingers. Sound familiar?

    You have what I like to refer to as CNS or “crappy neck syndrome”. You have four consecutive discs in your neck that are degenerative. The upper three discs bulge and efface the thecal sac, the sack of water (CSF) that surrounds the spinal cord. By your description, other than at C6-7, these bulges do not compress the spinal cord. These upper discs can cause local neck pain but should not cause arm pain if they do not press on the nerve roots.

    What is the percentage of neck pain vs. shoulder and arm pain? This makes a big difference in prognosis. If you have mainly neck pain (let’s say 70%) and only 30% shoulder and arm pain, surgery for the C6-7 level will probably only give you 40-50% total relief as the neck pain is most likely caused by all the problem discs. Fixing one disc will only relieve about 20% of your neck pain (about 1/4th of 70%) and should eliminate most of your arm pain (the remaining 30% due to arm pain for a total sum of about 50%)

    If we turn the numbers around and assume you have 30% neck pain and 70% arm pain, then you can speculate that you should have a total of 80% relief of pain (1/4 of 30% is about 10% and then add elimination of the 70% of arm pain for a total of 80%).

    There are some bold assumptions made with that prognosis but that is the general thought process for relief of pain by surgery.

    Grinding and popping in the neck is normally related to the facets. Normally, noises made by the neck are not painful but if you do have pain, degenerative facets could cause this. Do you have a degenerative spondylolisthesis on your flexion/extension X-rays (see website for explanation)? If the facets do generate pain, these can be diagnosed by facet blocks and possibly pain reduction could come from rhizotomies (see website).

    Visual disturbances, ringing in the ears and trigeminal neuralgia are all mediated by intracranial processes and are not my specialty. You would have to consult a neurologist for information on those processes.

    An elevated white count could originate from many different processes. If you have an elevation from your autoimmune process, this elevation should be able to be ruled out as an infection by the appropriate specialist (rheumatologist or hematologist). This should hopefully clear the way for surgery (most likely an ACDF) at C6-7.

    Dr. Corenman

    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.
    Post count: 2

    Dr. Corenman,
    Thank you so much for your reply. I was having so much pain and had developed several other problems. There was swelling and a buldge on the right side at the base of the skull that was very painful and the twitch in the upper lid was more frequent. the left eye was starting to develop the same deep twitch/spasm (not just a little eyelid thing going on) and there is pain in the left shoulder and side of my neck so my doctor ordered another MRI. the findings were: Vertebral bodies are stable in their height and marrow signal. No development of a foramen magnum or cervical cord lesion.
    The patient shows development of about 3mm of C3-4, C4-5 and C5-6 spondylolisthesis.
    C2-3 Within normal limits without change.
    C3-4 There is facet arthropathy and disc bulging, progressive disc bulging, not causing central canal stenosis or foramen stenosis.
    C4-5 There is a broad disc osteophyte protrusion, more bony, bilateral foramen stenosis with attenuated CSF in the root sleeves. The central canal is patent. No change.
    C5-6 Broad disc osteophyte bulging and facet arthropathy. no central canal stenosis. No foramen are patent. No detrimental change.
    C6-7 There is a broad osteophyte with a tight right foramen stenosis by uncovertebral joint hypertrophy. left foramen also shows some narrowing, but less so. No change.
    C7-T1 No disc protrusion, central canal or foramen stenosis.



    Needless to say I do not understand what any of this means and again would greatly appreciate your help. My pain and other problems seemed to be only affecting the right side with rarely minor pain and eye twitching on the left side. In the last three months the pain in the left side of my neck and shoulder area have increased with deep twitching in the left eye so bad that at times I am uncomfortable being in public and afraid to drive myself not knowing when and how bad it will be. With both eyes twitching at the same time now I am quite a sight and very uncomfortable with the resulting vision problems and unable to wear my contacts anymore. The pain in the left side of my neck and left shoulder area have become more debilitating than those I experience on the right. My doctor wanted to do a rhizotomy on the right side due to swelling and tenderness that had developed at the base of my skull on the right side but it has slowly gotten better over the last three weeks. I am reluctant now to pursue this plan for treatment in light of the new MRI and the increasing pain and eye problems on the left.
    Again I would appreciate any insight you have into my ongoing situation. I am curious as to why and how the initial injury seemed to affect the right side only, and as time has gone by I have developed problems on the left side also. I don’t understand my doctors explanation of subluxation and that several discs had shifted forward by 3mm now. I won’t go on anymore I am sure you will understand what the problem is from the MRI results than from any explanation I could relay that I was given.
    Thank you again so much for taking the time to help me.


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