[hohman1118]

#7169

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]

#8162

You do have significant degenerative changes in your neck. You have to define the pain generators as findings on an MRI may or may not be important to pain generation. I can tell you that the C3-4 level might contribute to local neck pain but will not cause arm pain as this nerve (C4) does not travel into the arm.

More likely than not, the arm pain is from the C6-7 level as this nerve radiates into the middle of the hand. You do have C5-6 foraminal narrowing and this too could cause arm and hand pain (normally into the thumb side of the hand however).

Inner arm pain and numbness into the small fingers could be from something else altogether. The ulnar nerve can become entrapped in the shoulder (thoracic outlet syndrome) or in the elbow (cubital tunnel syndrome). A good physical examination will deduce this and help to identify the pain generators.

Injections can help to predict the final surgical diagnosis as well as possibly give long term relief.

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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