[kcurtis600]

#31434

I am a 63 year old male, began experiencing increasing stiffness and pain in neck. Initially thought muscle related. Random and brief episodes of tingling in left thumb, index finder and slight tingling in left arm when driving, left hand in 10:00 position, tough tingling has subsided in last few months. Left sided headaches from jaw, temple, back of eye began about six months, four months ago developed vertigo when lying down to go to bed and when sitting up from bed, about 5-10 seconds but has occurred daily. Cervical MRI result:

Congenital spinal canal stenosis with AP dimension the osseous central canal measuring 10-11 mm in midline.
C2-3; Small central disc protrusion with mild central canal stenosis, moderate left neural foraminal stenosis and moderate left hypertrophic facet arthropathy.
C3-4; Small central disc protrusion with mild central canal stenosis,mild bilateral neural foraminal stenosis and moderate left hypertrophic facet arthropathy
C4-5; Central disc protrusion and endplate osteophyte with severe central canal stenosis and cord compression (left greater than right), T2 hypersenintensity within the lateral aspects of the cord suggests myelomaiacia, moderate left and severe right neural foraminal stenosis, and compression of the right C5 nerve root.
C5-6; Moderate disc degeneration with moderate central canal stenosis and mild ventral cord flattening, severe right and severe right neural foraminal stenosis, and mild effacement of the right and compression of the left C& nerve roots

Had a complete evaluation by neurosurgeon, with the main neurological finding was hyperrflexia in the left knee, everything else was good. He certainly believes surgery is warranted based on MRI (believes it would be a two level ACDF) but said a conservative approach carefully monitoring any progressive symptoms would be acceptable.

I’m torn between surgery now or waiting, would much appreciate your thoughts.

[Donald Corenman, MD, DC]

#31438

Your findings are significant. The upper cervical spine has left degenerative facet disease (C2-4) which can cause left sided headaches. (“C2-3; moderate left hypertrophic facet arthropathy…C3-4 moderate left hypertrophic facet arthropathy”).

Your C4-6 levels are worrisome for spinal cord damage due to canal compression (“C4-5; Central disc protrusion and endplate osteophyte with severe central canal stenosis and cord compression (left greater than right), T2 hypersenintensity within the lateral aspects of the cord suggests myelomaiacia”. and
“C5-6; moderate central canal stenosis and mild ventral cord flattening, severe right and severe right neural foraminal stenosis, and mild effacement of the right and compression of the left C& nerve roots”) which can explain the left hand tingling.

If you have cord compression with signal change in the cord (scar), in my opinion, you need ADCF surgery and sooner than later. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ and https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/.

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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