[hohman1118]

#7168

Hello Dr. C.,
11 years ago I was involved in a near fatal MVA. Since my ACDF, I have had progressive pain (mostly in the last couple of years) in my neck and increasing numbness to my right inner arm and 4th and fifth fingers including palm. I have had some numbness and tingling to my left as well but not as much. Weakness accompanies the above symptoms and also coldness. I have also noticed numbness in my abdomen (weird I know). I have tried everything over the years mostly on my own. Initially I tried TENS, PT, hot/cold packs, Steroids, injections, NSAIDS, Muscle relaxers( highly allergic to those though). Wish not to take narcotics due to their limited help and also I have young children. I am a healthy 42 year old female that is active in youth sports. I am not over weight or engage in any risky behavior or habits. My doctor finally talked me into the MRI although I have been reluctant because I am quite sure I need another surgery. I have come to terms with the need to be more aggressive in treatment but I was wondering what you think so that I can be more aware of options. Thank you in advance!!
MRI Findings:
alignment of spine normal. There is anterior cervical discectomy and fusion c4-5. mild bone marrow edema is present at superior endplate of c7. there is a cord signal abnormality at c7 level consistent with degeneration. Otherwise the cord demonstrates normal signal without mass or syrinx.
There is multilevel degenerative disc disease as detailed below:
c1-2: normal
c2-3: posterior ligamentous hypertrophy with mild canal stenosis.
c3-4: annular disc bulging and posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate neural foramina narrowing.
c4-5: discectomy with fusion. no canal stenosis or neural foramina narrowing.
c5-6: annular disc bulging posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate to severeneural foramina narrowing.
c6-7: right paracentral disc protrusion resulting in right neural foramina narrowing. posterior ligament and hypertrophy.
c7-t1: normal.
Impression: c4-c5 ACDF. multilevel degenerative disc disease as described above worst at c3-c4 and c5-c6 with canal stenosis and mass effect on the cord.

[Donald Corenman, MD, DC]

#7235

Sorry about the delay. I responded to you but the return post must have become lost in the ether.

After a near fatal MVA and the need for a one level ACDF, there were probably other non-surgical neck injuries that after some years start to become more degenerative.

“Mild bone marrow edema is present at superior endplate of c7. there is a cord signal abnormality at c7 level consistent with degeneration”. Bone marrow edema is typically associated with significant degenerative disc disease and is commonly a neck pain generator. Cord signal change is typically an injury to the cord from compression. Why the radiologist called it “consistent with degeneration” does not make sense to me.

The cord does not typically “degenerate”. Normally, stenosis or narrowing of the canal causes cord compression and signal change but the radiologist notes the worse canal narrowing is at C3-4 and C5-6; “canal stenosis and mass effect on the cord”. The MRI report does not make much sense to me. Maybe the radiologist misdictated the levels.

Your arm pain could be generated by compression of the right C6 or C7 nerves; “c5-6: annular disc bulging posterior ligamentous hypertrophy resulting in mild canal stenosis and mass effect to cord with bilateral moderate to severe neural foramina narrowing.
c6-7: right paracentral disc protrusion resulting in right neural foramina narrowing. posterior ligament and hypertrophy”

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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