[bardogg]

#9831

Dear Dr. Corenman- thanks for putting this very helpful site together.

I’ve recently been diagnosed with cervical and lumbar stenosis. I’m getting an EMG today and have a follow-up with a neuro specialist (non-surgical) in Jan. I’m hoping you can give me your sense of the situation, especially the chances that I might need surgery.

I’ve read a bit about stenosis and my sense is that it’s either surgery or wait–there’s really nothing in between, correct? My symptoms are annoying but not debilitating by any means, but I don’t want to risk avoidable nerve damage.

Symptoms:
I have persistent numbness/tingling in both pinkies and my right foot. These symptoms have been ongoing for over 1 year. I also get occasional radiating pain down my right thigh, which I think is disk-related. Recently my lumbar region has been persistently achy.

At the neuro appt I couldn’t walk straight with my eyes closed w/o stumbling. Finally, I think my grip in both hands is weakening and that I may be getting clumsier.

Thanks for any advice/reactions. Here are my MRI results, cervical first then lumbar:

HISTORY: Neck pain with radiculopathy.

COMPARISON: None.

RESULT:

Counting reference: Craniocervical junction.

Alignment: Alignment is anatomic.

Craniocervical junction: Craniocervical junction is normal.

Cord: Cervical spinal cord is normal in signal intensity.
Bone marrow signal/fracture: No evidence of pathologic marrow
infiltration. No evidence of prior fracture.

Cervical soft tissues: The paraspinal soft tissues are unremarkable.

C2-C3: Canal and foramina are patent

C3-C4: Uncovertebral change mildly narrows the left foramen. The
central canal and right foramen are patent.
C4-C5: Uncovertebral change moderately narrows the left foramen. The
central canal and right foramen are patent.

C5-C6: Interspace is moderately narrowed. Prominent disc osteophyte
change is asymmetric to the left with mild ventral lateral cord
compression on the left, severe left and mild to moderate right foraminal
encroachment.

C6-C7: Interspace is mildly narrowed. Prominent disc osteophyte change
the left results in mild ventral lateral cord compression with severe
left foraminal encroachment. Right foramen is patent.

C7-T1: Canal and foramina are patent
IMPRESSION:

Diffuse cervical spondylosis notable for mild ventral lateral cord
compression on the left and severe left foraminal encroachment C5-6 and
C6-7. Foraminal encroachment and additional degenerative changes as
detailed above.

RESULTS:
There is minimal degenerative loss of disk height at L4-L5 and moderate
to severe degenerative loss of disk height at L5-S1.

L4-L5: Mild generalized bulging disk with questionable superimposed
shallow broad-based right foraminal disk protrusion, mild degenerative
facet and ligamentum flavum hypertrophy combine to cause mild bilateral
foraminal stenosis. Central canal patent.

L5-S1: Mild generalized bulging disk with superimposed shallow
broad-based right foraminal disk protrusion, degenerative facet and
ligamentum flavum hypertrophy combine to cause severe right and
mild-moderate left foraminal stenosis. There is asymmetric narrowing of
the right lateral recess. Central canal patent.

[bardogg]

#9839

I just received the EMG results. They tested only my hands and forearms and did the needle testing only on the right side. I’ve pasted the results below. Does this mean that the cervical stenosis is not causing any nerve problems and that I only have CTS?

Thanks, again, for any advice.

IMPRESSION:
Extensive electrodiagnostic examination of the right upper
extremity and additional nerve conduction studies of the left
reveal evidence of a right median neuropathy at or distal to the
wrist (carpal tunnel syndrome) which is mild in degree
electrically. There is no definite evidence of a superimposed
right cervical motor radiculopathy. A cervical sensory
radiculopathy cannot be excluded by a study of this nature.

[Donald Corenman, MD, DC]

#9842

EMGs are great tests when you are looking for peripheral neuropathy including compressive neuropathy (like carpel tunnel syndrome). EMGs will be useless if there is pain and numbness caused by a nerve root compression in the neck or lower back but without motor weakness.

If there is motor weakness present, the EMG will identify the nerve root involved but a good history and physical examination will do the same without the additional cost of the EMG test.

If there is myelopathy from cord compression, the EMG test will be useless as it cannot test cord function.

Unfortunately, EMGs are over ordered and do not help with diagnosis in most cases of radiculopathy (nerve root compression causing arm or leg pain).

This EMG test notes the presence of carpel tunnel syndrome but you did not complain of hand numbness on the thumb side so this finding may be unimportant.

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.

[bardogg]

#9844

Thanks for that helpful analysis. If you don’t mind, I have a couple of follow-up questions:

1. This means that I still may have cervical radiculopathy/myelopathy? I don’t have severe symptoms; the most obvious are persistent numbness/tingling in both pinkies and in my right foot (although the foot is more intermittent).

2. What should the exam look for (and is there anything I should pay attention to) to identify either radculopathy/myelopathy (and how can I tell the difference)?

3. I don’t have a follow up appt until Jan 6 with the spine doc. His only comment on the EMG (they post the results online) is that I have mild CTS on the right side and to “keep current schedule and plans–which is just the Jan appt. Should I ask about PT or try to get in to see someone else sooner?

Thanks, again, for the help. I’m going a little crazy trying to figure out what’s going on/what to do.

[Donald Corenman, MD, DC]

#9852

You still may have radiculopathy or myelopathy without a positive EMG test. Both of these diagnoses are made through a good history and physical examination along with identifying images (X-ray and MRI).

The examination finding for myelopathy and radiculopathy are too complex to go through on this thread. If you really want to fully understand the exam findings, see the chapter in my book “The Clinician’s Guidebook to Lumbar Spine Disorders”. Short of that, see the sections on radiculopathy and myelopathy on this website.

Numbness in the bilateral pinkies can originate from cubital tunnel (elbow), Guyon tunnel (wrist) or thoracic outlet disorders. Myelopathy rarely causes solely pinky numbness.

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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