[Jonesy]

#22640

Hello Dr. Corenman,
I am looking for some help. I started out with shoulder pain some time back that just got worse and worse. pain started down my arms and hands and then i ended up with temporary paralasis of my arms. i went to my doctor and he said i had carpal tunnel so he sent me for an EMG. the Neuro said that i did have carpal tunnel but that she thought i also had Cervical Dystonia. my PT suggested a second opinion so i got a new doctor. She sent me to get an MRI and they found this:
The visualized part of the posterior fossa, craniocervical junction, paraspinal soft tissues
are unremarkable. The bone marrow signal intensity is within normal limits. No
significant signal abnormality is seen within the spinal cord parenchyma.

C2-3: There is a small central posterior disc protrusion without significant stenosis.

C3-4: There is a broad posterior disc protrusion causing a small ventral impression
upon the dural sac, mildly narrowing the subarachnoid space.

C4-5: There is disc space narrowing with posterior endplate spurring, and associated
posterior disc herniation. There is also prominence or buckling of the dorsal ligaments
contributing to severe stenosis of the spinal canal. There is bilateral neural foraminal
stenosis. There is abnormal hyperintensity within the spinal cord parenchyma.

C5-6: There is disc space narrowing, and there is a posterior disc herniation more
prominent to the right of midline, compressing the right anterior aspect of the spinal cord
and likely impinging upon the ventral nerve roots. There is moderate stenosis of the
right neural foramen and mild narrowing of the left neural foramen.

C6-7: There is disc degeneration with disc space narrowing and a broad posterior disc
protrusion narrowing the subarachnoid space.

IMPRESSION:
1. Severe spinal canal and neural foraminal stenosis at C4-5 with spinal cord edema.
2. Prominent right posterior disc herniation at C5-6 and other degenerative changes as
above.

My nuerosurgeon told me that if i didnt have surgery that i would be paralized from the neck down. so i had it done. i woke up from surgery and could hardly walk. my legs shook so bad i could not stand, but they sent me home anyway.it took me a month to be able to walk half way normal but the tremors and extreme wide gait on left was still there. at my next post op check up i told the doctors assistant, (who was surgery assistant) about my hands and shoulder pain coming back so he sent me for another MRI.FINDINGS:

The patient is status post anterior interbody fusion at C4-C5 and
C5-C6. The patient has undergone partial corpectomies from the previous study.
The central canal is patent at these levels of surgery, as are the lateral
recesses and neural foramina. There are some changes of myelomalacia involving
the cord at the C5 level, similar to the previous study.

There is posterior spondylosis at C3-C4 that is causing thecal sac effacement.
However, the cord is not deformed. The lateral recesses and neural foramina are
widely patent at this level. Similar findings are seen at the C6-C7 level.

C2-C3 and C7-T1 demonstrate widely patent central canals, lateral recesses, and
neural foramina. There are no perivertebral abnormalities.

IMPRESSION: The patient is status post anterior interbody fusion at the C4-C5
and C5-C6 levels. The central canal and lateral recesses are patent at these
levels. There are some persistent changes of myelomalacia involving the cord at
C5. No significant neural compressive abnormalities are present.

i went to a sleep doc and he said i now have Clonus, Hoffman’s Reflex, Hyperreflexia, babinsky, restless leg syndrome, sleep apnea, and wide gait in walking. i dont understand why all of this came on AFTER the surgery when i didnt have it before surgery.

The Neurosurgeons assistant told me that none of my symptoms have anything to do with the surgery and that there is something else wrong with me. I am so confused and scared of everything i have read about these findings. i still cant feel anything in my hands and the pain is excrusiating.

Now after going to have a leg EMG that was negative and xrays of lumbar region that were also negative now they want to send me to a new neurologist to check for Multiple Sclerosis. no one seems to know what is wrong with me.
I have been on cymbalta, and gabapentin with no help, so after all the second checking the leg EMG doc suggested Baclofen. so now i am on that too. It does seem to help the tremors but the pain is still there. can you help at all.

[Donald Corenman, MD, DC]

#22652

Surgery can cause further symptoms in a case of severe canal compression. The surgeon has to place tools into the canal when decompressing the bone and this added footprint can increase the cord compression. I assume this is what has happened in your case. All your findings are consistent with cord injury (“Clonus, Hoffman’s Reflex, Hyperreflexia, babinsky, restless leg syndrome, sleep apnea, and wide gait in walking”-except the sleep apnea). See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/. The canal is now decompressed (“The central canal is patent at these levels of surgery”) so you are probably in no current danger.

Neck pain should be reduced after surgery. Because it is increased, I would want to know if you have a solid fusion or if one level did not fuse (pseudoarthrosis). This would require X-rays and a CT scan.

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.

[Jonesy]

#22656

Oh Thank you for such a quick response! I did have Post Op xrays done 3 months out and this is what it said:
XR C-Spine 2 or 3 Views –
NUMBER OF VIEWS: 3
INDICATION: cervical myelopathy.
COMPARISON: Cervical spinal radiograph 2/2/2016. Subsequent encounter.

FINDINGS: The cervical spine is imaged through the level of C7 on sagittal imaging.
The patient is status post anterior fusion of C4, C5, and C6 with intervertebral disc
spacing devices. There is slight prominence of the prevertebral soft tissues, decreased
from earlier postoperative imaging. Findings may be projectional in nature. No acute
cervical spine compression fracture or acute subluxation is noted. Minimal degenerative
facet disease is seen.

IMPRESSION:
1. Status post anterior fusion of C4, C5, and C6 without evidence of acute cervical spine
compression fracture or subluxation.
2. Mild prominence of the prevertebral soft tissues, likely projectional in nature. If high
clinical suspicion for underlying infection or inflammation, further evaluation with MRI
could be performed.

Now on this appointment my surgeon’s assistant (who assisted in the surgery) told me that the x-rays looked great. (from me, a dummy, reading this, it does not sound good)
He told me that the leg and all the other problems had NOTHING to do with my injury or the surgery. This is when i demanded the 2nd MRI and he said that those results were fine and everything looked normal??? Does this sound at all right from what you have seen? I feel like i am being not told the whole truth about how bad my injury is or how the surgery truley went. they tell me that they can’t even tell me if there was sucess for at least a year and a half, but the surgeon said i am basically good to go. What is the MYELOMALACIA on the second MRI mean? this word really scares me.
Thank you in advance for your response

[Donald Corenman, MD, DC]

#22663

The radiologist did not comment on fusion status but just on the “spacers” placed in the disc spaces. Your fusion status is currently unknown. How long are you out from surgery?

The assistant stating that your symptoms have nothing to do with surgery is probably not accurate. Also looking at X-rays with your new and increased symptoms is unhelpful. The new MRI report does note a decompression has occurred so your cord at this point has no added danger.

Myelomalacia is the “thinning” of the spinal cord. The spinal cord bulk is made up of nerve pathways. When some of these nerves are injured and “drop out”, the diameter of the cord diminishes.

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.

[Jonesy]

#22664

Thank you again for the fast response!

I had surgery on 2-1-2016 I am supposed to see assistant again on August 11 and supposed to get another set of x-rays then. So I need to ask about fusion status then. Ok thank you I will. They want to send me to a neurologist for MS testing now because the assistant said what he did so I go in September for that. Can the Myelopathy (blood clot)? In my cord move? Or is it stationary. I am worried about that. Ive read that they can move. I am just frustrated because none of my doctors will explain it like you do. Thank you so much

[Donald Corenman, MD, DC]

#22667

Myelomalacia is injury to the cord due to compression. It is not as simple as a “blood clot” but injury to the nourishing vessels is part of the problem as well as direct injury to the nerves themselves. There is no “blood clot” and you don’t have to worry about a clot moving. There is however a condition called syringomyelia that can rarely occur to a cord injury area so an MRI down the road would be helpful.

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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