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Hello,
My Father suffers from chronic pain in the neck area and left shoulder due to degenerative disk disease, and an injury to the left shoulder rotator cuff with trapezius pain. He also has shaking of both the left and right hands. His quality of life has been greatly diminished. He is greatly weakened, with difficulty getting out of a chair, walking & getting restful feep at night. Could he possibly be a candidate for surgery? And, if so, are there any minimally invasive surgeries available? What type of surgery would be recommended? Here is a copy of the results of an MRI of the cervical spine done in December of 2011.
Results of an MRI of the Cervical Spine 12/15/2011 (Without Contrast):
HISTORY: 77 year-old male with history of left arm tumor and cervical disc disease. Patient states neck pain going into left shoulder with shaking in hands.
COMPARISON: None available.
TECHNIQUE: Multiple sequences were obtained in multiple planes through the cervical spine without contrast. GE 1.5 Optima high field magnet was utilized for this examination.
FINDINGS: This exam is limited by involuntary patient movement.
Scout images are unremarkable.
Flow voids of the major neck vessels are intact. No para or prevertebral soft tissue abnormalities are identified.
The posterior fossa including the cervical spine cord is normal.
Accentuated lordosis of the cervical spine is noted, which may be positional. Vertebral body heights, signal, and alignment are maintained.
C2-C3: Disks and facets are unremarkable. No canal or neural foraminal narrowing is demonstrated.
C3-C4: A central focal disk protrusion is identified, which measures approximately 9 x 3 mm in the transverse and AP dimensions respectively. Mild bilateral facet hypertrophy is noted at this level. There is mild right neural foraminal narrowing without significant left neural foraminal narrowing. Disk protrusion causes narrowing of the AP diameter of the canal to approximately 10 mm and places minimal mass effect upon the anterior aspect of the cervical spinal cord at this level.
C4-C5: Demonstrates circumferential disc bulge, ligament flavum thickening, and mild to moderate bilateral facet hypertrophy. Findings cause moderate bilateral neural foraminal narrowing. AP diameter of the canal at this level measures approximately 8mm.
C5-C6: Demonstrates disk osteophyte complex with superimposed left paracentral disk protrusion. Mild facet hypertrophy is noted at this level and there is ligamentum flavum thickening. Findings cause severe left and mild right neural foraminal narrowing. AP diameter of the canal at this level measures approximately 10 mm.
C6-C7: Demonstrates disk osteophyte complex with mild bilateral neural foraminal narrowing. The canal is patent at this level.
C7-T1: Unremarkable.
IMPRESSION:
1. MULTILEVEL DEGENERATIVE DISK DISEASE, MOST SEVERE AT THE C4-C5 LEVEL WHERE THERE IS NARROWING OF THE AP DIAMETER OF THE CANAL TO APPROXIMATELY 8MM.
2. VARYING DEGREES OF NEURAL FORAMINAL NARROWING AT MULTIPLE LEVELS, DETAILED ABOVE.I thank you so much.
The MRI does note significant changes that could cause some of your father’s symptoms. “Shaking” however is unlikely to be associated with cord or root compression. Remember that the MRI findings have to be correlated with a very thorough history and physical examination. The radiologist also noted a history of “tumor” in the left arm. This could also affect the symptoms depending upon the type of tumor.
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.Thank you so much for your reply Dr. Corenman.
Prior to the MRI he had a CT done. My father stated that his neck pain was the result of a motor vehicle accident in October 2012. He had the CT Spine Cervical 10-28-2010. The findings were as follows:
FINDINGS – The alignment is normal without evidence of subluxation or fracture. Degenerative disk disease with anterior and posterior osteophytes is evident at C5-C6 and C6-C7. Posterior disc bulges are evident at C2C3 and C3-C4. Posterior disc bulges are evident at C2-C3 and C3-C4. Posterior disk/osteophyte complexes are evident at C4-C5, C5-C6, and C6-C7. These findings may be chronic in nature. Clinical correlation is recommended. If there is concern of acute soft tissue injury, magnetic resonance imaging could be considered.
IMPRESSION-
1. CHRONIC DEGENERATIVE CHANGE.
2. NO ACUTE ABNORMALITY IS IDENTIFIED.He had seen a chiropractor in the past with some relief, and is currently seeing a physical therapist 2 times weekly. Regarding the tumor, I will have to find out more about that. I do have a copy of an x-ray of the left shoulder that he obtained from the chiropractor. I do notice a lot of muscle loss/wasting of the muscles in my father’s left hand.
What would you believe to be the next course of action? I would like to help my father obtain some relief, as he is very depressed & his ability to get around is so diminished.
Thank you again Dr. Corenman
The CT scan does not shed light on the diagnosis. You father needs a good spine surgeon to go over him with a fine tooth comb to understand the disorder and suggest a treatment program. I cannot say based upon the available information if you father is a surgical candidate.
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.Thank you Dr.Corenman for helping me to understand.
Could you possibly recommend a good spine surgeon in the Orlando/Tampa, FL area?
Bless you for your compassion.
Dear Dr. Corenman,
I spoke to my father today & luckily he does not have a tumor in the left arm. It was just a transcription error & “tumor” was meant to be tremor. Any referral that you might give for a good spine doctor in the Tampa/Orlando area would be so appreciated.
Thank you again & have a good evening.
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