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Hello Dr. Corenman,
Hope all is well with you and your family! I would like to thank you for providing this forum. I have found many useful topics.
I was wondering if you would be kind enough to look over the results of my cervical MRI from 5/23/2012. The report is as follows:
45 year old/male No prior surgery.
Procedure: MRI Cervical W/O Contrast.
Technique: T1 and T2 sagittal and axial images were obtained through the cervical spine.
Findings: The visual spinal cord signal is normal. The visualized fossa contents are normal. There is no acute pathology at C2-C3, C3-C4, C4-C5 or C5-C6.At C6-C7 the patient has a left paracentral disc protrusion, which effaces the anterior thecal sac and abuts the cervical cord. It measures approximately 4 mm anterior to posterior and approximately 1 cn left to right. The AP diameter of the canal is narrowed to approximately 7mm in the region of the protrusion. The protrusion extends about one-third of the way up the posterior aspect of the C6 vertebral body. The bone marrow signal is normal.
Impression: Left paracentral disc protrusion at C6-C7, which effaces the thecal sac and abuts the left side of the cervical cord. There is moderate canal stenosis as described above, no cord edema is identified at this level. No other abnormal findings.
My symptoms are: Neck pain, left shoulder pain radiating down my left arm. I also have numbness in the fingers of my left hand( tingling, pain in my middle finger and the finger next to my thumb). At times it feels like my fingers are asleep. I have a deep burn between my shoulder blades.
Also and the most troubling: I feel like I have some symptoms of occipital neuralgia. These symptoms started when my neck pain started. I have pain in my neck on the left side and the base of my skull that travels over my head and stops around my hair line on my forehead. I also have left ear pain and left jaw pain. The occipital pain issue is at its worst when my neck pain is at its worst. These symptoms are not always present but flair up 5-6 times a day. The headaches associated with this are very severe and debilitating (the worst ppain I have ever experienced)
I see a pain management Dr. for a annular tear at L4-L5 that I have been managing for approx 15 years. The low back pain is still present but is now underlying since my neck issue starter. I did not have any trauma to my neck and I don’t know what brought this issue on.As a side note I participated in a clinical trial for my low back. I was in the Spinal Restorations Biostat Biologx Fibrin Sealant clinical trail. I was followed for 18 months as part of this trial. I did learn after the trial that I did receive the actual study drug. I had very good results for about 6-7 months. After approx 7 months my symptoms returned (low back pain, left hip and knee pain). I would assume since the fibrin sealant is resorbable it is not intended as a long term fix. Talking with the Doctor that was facilitating the trial my results were about average for most participants.
When I visited my pain Doctor today he looked at the film and report and asked me if I wanted to have the herniation removed. Well, of course I don’t want to have surgery and want to explore all other options before I burn that bridge. Since my pain Dr does not do procedures he is scheduling a block with the Doctor who did the clinical trial.
I guess my questions are: 1) Would you please be kind enough to explain in plain English what the report is saying? I saw the films and the even to my untrained I could see the bulge.
2) What would be your recommendation as far as a treatment options? 3) Can lasers be used to treat a ruptured disc? Would laser surgery be less invasive that open neck surgery?I have had to many epidurals in my low back to even count. At first they really helped and I would be able to go 12-18 months between blocks. Now I am having 3-4 a year to keep my pain manageable and I am starting to think I may just be postponing the inevitable.
If surgery ends up being the route I go I would like to explore having a artificial disc replacement rather than fusion as to maintain full range of motion.
Sorry to be so long winded but I wanted to give you as much information as I could.
Would you be willing to treat patients that would have to travel to you? I live in Alabama and I am looking for the best Physician available if I have to go the surgery route.
Again, thank you so much for the providing this platform for people like me who suffer from spinal problems and struggle to find relief.
Warmest regards,
Michael
AlabamaYour symptoms are classic for a C7 left radiculopathy from a herniated disc at C6-7. You also have greater occipital neuralgia- most likely from tension at the base of the skull. The C7 nerve compression will cause pain at the top of the shoulder (the trapezius) between the shoulder blades (the thoracic spine) and down the arm into the middle fingers of the hand involved. “Numbness’ and pins and needles will accompany the radiation of pain.
The symptoms should typically get worse with head extension (bending the head backwards) and better with head flexion (bending forward). See website under cervical herniated disc for more information. Many people will get relief by taking the forearm of the affected arm and lying this forearm on the top of the head (the Bakody’s maneuver).
Most likely, the headaches are from irritation of the greater occipital nerve (C2) which originates in the back of the skull and radiates over the head to end right above the eyebrow. There are rare occasions that this C7 herniation can cause these headaches directly but more likely, this is a muscle tension headache that is irritating this nerve from the protective spasm in the back of the neck.
The MRI is classic for this particular disc herniation. “At C6-C7 the patient has a left paracentral disc protrusion, which effaces the anterior thecal sac and abuts the cervical cord. It measures approximately 4 mm anterior to posterior and approximately 1 cn left to right. The AP diameter of the canal is narrowed to approximately 7mm in the region of the protrusion. The protrusion extends about one-third of the way up the posterior aspect of the C6 vertebral body”. This simply means that this herniation is compressing both the left C7 nerve and the left side of the spinal cord.
You do also have some cord compression as noted by the radiologist. Do you have symptoms of imbalance, incoordination or symptoms in any other extremity?
The question is “do you need surgery”? Please read the section under “treatments”- “When to have neck surgery” for more information. Do you have significant motor weakness? This would be the triceps muscle, the wrist flexors (bending the wrist towards the palm) and the MCP extensors (pushing the fingers back against resistance). Can you do a push-up with equal strength on both sides?
If you do not have weakness or signs of myelopathy (see website), you could undergo a program of physical therapy and epidural injections to reduce the pain. This could be a long term successful treatment.
Surgically, you are most likely a candidate for an ACDF or an artificial disc replacement of that level (see website and videos). Because the herniation is compressing the spinal cord, you would most likely not be a candidate for a posterior foraminotomy. Despite what you can read over the internet, lasers are not for spine surgery in my opinion. Lasers burn and vaporize tissue and if they are not perfectly focused, burning of the surrounding structures can occur. A simple visual meticulous mechanical removal of the herniation yields the best and safest results (microdiscectomy before either fusion or disc replacement).
About 65% of my patients travel from out of town to see me. The Steadman Clinic has a routine for patients that travel. If you have any questions, please call my office at (970) 476-1100.
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.Dr. Corenman-
Thank you very much for taking time away from your family on a holiday to answer my questions.
You asked:
You do also have some cord compression as noted by the radiologist. Do you have symptoms of imbalance, incoordination or symptoms in any other extremity? Yes, but I had not tied the two together. I have noticed recently that I will lose my balance relatively easy. I will be walking and lose balance and bump in door frames, desk..I most certainly get relief by placing my left forearm on the top of my head. Due to the sensitivity of my scalp during the occipital nerve related headaches I am not able to do this often. I have pain at a 4-5 in my neck at all times. When it flares to a 7-8 (5-6 times daily) the headaches intensify also and my scalp is just too sensitive to touch.
I sell medical grade plastics used in instrumentation and sizing trials. With my career, I have had the opportunity to meet many Orthopedic surgeons and Neurosurgeons. A few days after my MRI I ran into one of the Neurosurgeons I work with and he looked at my MRI and did a quick exam. As part of the exam he had me squeeze his fingers, he pushed and pulled on my forearms in different positions and noted that I have significant weakness in my left arm. Since your first reply I tried the push up and I did not have equal strength in both arms. My left arm was rather weak. I saw this Physician before for my lumbar back condition and he sent me to pain management since I was reluctant at that time to have fusion at L4-L5 so he is pretty familiar with my condition.
After the quick exam and reviewing my MRI he said his opinion was the disc needed to come out weather I used him or not. He urged me to not wait around like I did with my low back and stated that I should be concerned with possible permanent nerve or spinal cord issues if my condition deteriorated further. He lead me to believe that the cervical spine might not be as forgiving as the lumbar spine.
I am much more concerned about my cervical spine issue than I was about my lumbar problem. Maybe because I am much older now and take these kind of things more serious. I have a 20 year old daughter, 15 year old son and a 4 year old son. Being 45 with a 4 y/o I need to get healthy and stay health so I will be around and able to participate in raising him.
A couple of quick questions if you would: My L4-L5 disc has flared up recently and I was thinking of getting a block. Based on your experience in your practice would you consider doing a block at L4-L5 AND C6-C7 at the same time? Or, do you find it better to spread them out over a several week period?
I now have a total of three disc problems. C6-C7, L4-L5 and one in my thoracic spine that was found by chance via MRI as part of the workup before I participated in Spinal Restoration Bio-Stat fibran sealant clinical trial. It has not caused any issue and I don’t remember the exact location.
What could be the cause of all these ruptures? I am 45 years old and other than this I am relatively healthy. Would this be a genetic issue? If it’s a genetic issue is this something my children could possibly experience later in life?
What are your thoughts on the use of sealants in disc? It is my understanding that sealants have been used in Europe for many years. It looks like there are several companies working on FDA approval for sealants. Are you aware of any that are currently approved for use in the USA? Are you familiar with the Biostat Biologx Fibran Sealant? It would be nice if there was a product that was a more permanent nature. I was sedated so I am not sure about the pain involved during the procedure but the post procedure pain was significant and they asked that we try to manage it with OTC meds if possible. If narcotics were required if would not disqualify you from the trial. I don’t think anyone who received the actual study drug would be able to get by on OTC meds I know i was not able too.
Thanks again and I will be contacting your office and look forward to seeing you soon.
Warmest regards,
Mike Couch
Based upon your symptoms and “findings” of weakness and especially imbalance, you most likely need surgery of C6-7. It is interesting that as a general rule (with some exceptions) the cervical nerve roots are more forgiving than the lumbar nerve roots (a later surgical decompression can still allow recovery in the cervical spine). The exception is cord compression. The cord is part of the central nervous system (CNS) and does not recover well. If you have symptoms of cord compression along with some signs (hyperreflexia, Hoffmans’ sign, imbalance signs), surgery should not be ignored.
The disc tears/herniations in your cervical, thoracic and lumbar spines indicates a genetic weakness of the discal collagen fibers. There is nothing you can do for that but just learn better spinal biomechanics and take greater care when loading your spine.
You can get a block of both the lumbar and cervical spine at the same time but in regard to your cervical spine, this would be a mistake in your case. The epidural will relieve your pain but not remove the compression of the spinal cord. You are then lulled into the belief that you are “better” because the symptoms are not as disabling but that conclusion would not be accurate. The cord compression would continue, possibly leading to further damage.
Sealants for the disc really do not seal the discal tear. The biology of the annular wall of the disc is that it is avascular. Without a blood supply, there is no ability of the disc wall to repair itself. In addition, the fibers of the disc wall are under great tension. When they tear, these fibers retract so they cannot be approximated again.
Some of the injections you mention reduce the inflammation of the pain fibers in the disc wall and that is what reduces the back pain. Unfortunately, these injections are only a temporary fix.
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.I ended up having ACDF yesterday in Birmingham, Al. My left arm pretty well went numb and I was also having memory loss. I have been wondering if the memory loss could be traced back to spinal cord compression.
My Pain Management Dr has talked to me about trying Suboxone for pain management since I was starting to worried about taking pain meds with all the tylenol and the damage it could be doing to my liver. He felt Suboxone would treat my pain well. I was willing to give it a try. It really did not work very well and I felt drugged after taking it.
I informed the nurses at pre-admit and also all the nurses and the anesthesiologist before I went into surgery. I came out of surgery in extreme pain and they could NOT control it due to the suboxone blocking all the pain meds they gave me post-op. The Doctor in post-op decided to give me morphine any way and he thought it would not hurt me and could possibly help me out. They decided to put me in Neuro ICU for the night to better help manage my pain. I came out of surgery around 11:30 am yesterday and the half-life of the Suboxone was up about 6pm. I pretty well had to just tough it out for about 6 hours. Very painful! But the surgery relieved all my left arm pain, occipital headaches.
All the feeling has come back in my arm.I spoke with your nurse and was in the process of sending her my MRI disk and paper work. Once I lost all the feeling in my arm I decided along with my Neurosurgeon that I needed to get this surgery done ASAP.
I am glad that I went ahead and had the surgery as the results have been amazing so far.
I have a Medtronic piece of PEEK and Medtronic plate and screws in my neck.
To all the people who are reading this: Don’t be scared to have this surgery done. Find a qualified surgeon and you will get great results. I do not believe laser surgery is justified in neck and back surgery. My Neurosurgeon has “fixed” over 20 people who went to Florida and paid a ton of money to have spine surgery done via laser. The laser places in Florida are just there to make a ton of money for the owners.
Thank you soooo very much for all your help. I hope to never have this issue again but if I do, I will be headed to Colorado to visit your clinic.
Warmest regards,
Mike Couch
Dear Dr. Corenman,
I’ve had my cervical spine MRI last August 22, 2017 and my findings were: loss of normal cervical lordosis suggesting muscular spasm, mild diffuse disc bulge at C3-C4 with no stenosis, mild diffuse disc bulge at C5-C6 with no stenosis, small top moderate paracentral disc protrusion with osteophyte complex at C6-C7 mildly touching the left C7 nerve root. The central canal and neural foramina are patent. Intact facet joints. Unremarkable cervical cord. Maintained Vertebral alignment. Maintained vertebral body heights.
IMPRESSION: Moderate left paracentral focal disc protrusion at C6-C7
The radiologist explained to me that this is because of my posture (I’m working a Secretary and basically infront of the computer for almost 8 hours a day) but I still don’t need a surgery which kind of scare me.
6 years ago, I also had the same test and I was also told I need to improve my posture but I ignored it. I usually have shoulder pain and muscled spasm on my shoulders and like a burning sensation. Lately I am feeling some pain on my neck and even noticed some cracking sound (not sure if cracking is the right term) and there are times that when I try to get up from bed, I feel like there’s something wrong with my neck (like it feels it will break lol). Other than these symptoms, I always have some nerve problems too and whenever I walk longer, my hands usually gets numb and lately my right index finger is also numb.
Could you please explain to me what is meaning of my MRI result? I could not see a Orthopedic Surgeon or a Neurosurgeon at the moment as it is holiday here and they will be back in two weeks and this bothers me.
Also, right side of my back is a little bit elevated than the left.
I would appreciate if you could give me some light on my question.
Thank you and more power.
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