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#6442

Dr. Corenman

Almost two years ago I saw my gp for what I described as dizzyness which came in spells and then went away until the next wave. I also complained of “walking into walls” on occasion. He prescribed meclizine for vertigo but after some blood work and a cat scan of the brain knew of no cause. The dizzyness still remains on and off today.

In the following year I suffered 6 or 7 falls, one of which cracked three ribs.

Last June I started feeling my feet burning at night and my legs started hurting and getting weaker. By August the burning reached as high as my butt and the legs continued to weaken to where I complained that it felt like walking was starting to be a chore. Climbing my stairs or simply getting out of a chair was so much harder and I would need help getting up to my feet if I bent down to put something in a cabinet. These problems just get worse through the day and sleep has become no more than nap time.

I saw the gp in September, 2011. I explained the problem and the fact that I also had what I assumed was a piched nerve which shot electric sparks down my right armpit to my elbow, but only occasionally and mostly in bed. and sent me for a nerve conduction study thinking I had neuropathy. The study showed mild axonal sensory peripheral neuropathy. Thus started the ever increasing doses of Lyrica and elavil to treat the burning pain. The drugs prevented fire shooting out but never stopped the burning. The trouble walking, the leg weakness and balance issues continued to worsen.

Around February I thought oh oh, the neuropathy was spreading into my arms as burning and pain began in them in earnest. I saw the gp in April and the gp wondered if that was the cause and ordered cervical xrays. When he received the report back his office called and they had already made the appointment with the orthopedic surgeon.

The orthopedic surgeon took a history, made an exam, especially neurological signs and ordered an MRI. He told me pre MRI I had myelopathy and that my cord was compressed but the MRI would confirm.

This is the MRI report:

No significant abnormalities at c2-3. At c3-4 there is left paracentral disc protrusion resulting in narrowing of the canal. There is also contact of the ventral aspect of the cord on the left without cord impingement.

C4-5: There is subtle flattening of the ventral aspect of the cord on the left due to a left sided disc protrusion and accompanying endplate spurring. There are degenerative facet changes on the right. There is mild to moderate foraminal narrowing, left greater than right due to these factors.

C5-6: There is left sided cord impingement due to a broad based left paracentral disc protrusion with accompanying spurring. Moderate left sided foraminal encroachment due to uncovertebral spurring. Moderate to severe right sided foraminal stenosis due to uncovertebral spurring.

C6-7: There is small right paracentral disc protrusion with mild resulting narrowing of the central canal. No significant foraminal stenosis or facet arthropathy. A small disc protrusion is also noted at C7-T1.

When I saw the surgeon he told me he actually disagreed with the radiologist going as far as to call his report lazy for leaving out measurements. He thought my condition was “much worse” than the report stated. He told me the spine was compressed to 3.72mm at c5-6 and in the other places the diameter was between 5 and 7mm.

His recommendation was ACDF for all discs between c3 and c7. He explained it will never get better on its own and the risk of doing nothing was probably not a good thing. He did not know if the symptoms would get better but without surgery would certainly get worse and with surgery probably will not worsen.

Thanks for your opinion

[Donald Corenman, MD, DC]

#6444

You have multiple symptoms that could be from difference sources. The burning in your feet that ascended to your legs and then buttocks sounds like a peripheral neuropathy. Did your hands become involved when the burning ascended into your knees? Peripheral neuropathy is fiber length dependent which means that when the knees are symptomatic, the hands start to become involved.

Compression of the spinal cord causes myelopathy. See the section on myelopathy to see if your symptoms are similar to the description. Poor balance is part of the myelopathy syndrome but not dizziness.

I am unclear if there is severe cord compression or not. The orthopedist notes severe cord compression but the radiologist does not. This is a dilemma. If the canal is truly less than 4mm at one level, this is severe compression. Try to get an overread of the MRI or send the images here to my office.

If cord compression is present, the surgery to decompress the cord depends upon multiple factors including number of levels, severity of the compression, angulation of the spine (kyphosis vs. lordosis) and mobility or instability.

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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