[APT]

#19242

I’ve been having some tingling and twitching in left hand off and on… forearm on left also is tight, as is the shoulder, and neck as a whole aches, my headaches are mostly left sided. I also feel like there’s a tight band around forehead at times.

That said, I am not in terrible pain daily at all. It comes and goes. The twitching in left hand/fingers lasted a couple days and isn’t there anymore. Temple pain on left comes and goes, neck is mostly an ache.

Anyway, here’s the conclusion:

CONCLUSION:

Diffuse cervical degenerative changes with a reversed lordosis in the neutral position and the following specific findings:

1. C6-7 2 mm AP left posterolateral disc herniation and endplate/unconvertebral spur causing moderate to severe left proximal foraminal stenosis with left C7 impingement.

2. C5-C6 moderate disc degeneration and mild right ventral cord flattening without central canal stenosis.

3. C2-3 mild to moderate left chronic foraminal stenosis, and moderate left facet degeneration. 1-2 mm spondylolisthesis in the neutral position, reduced in extension.

4. No acute fracture or destructive osseous lesion.

——–

What does that generally mean? I am terrified of surgery. My body doesn’t do well with any sort of anesthetic. I guess what I’m wondering is what does this MRI basically say is going on, is it super serious, and is it something I definitely need surgery for or can we try conservative treatment first?

Thanks!

Michelle

[Donald Corenman, MD, DC]

#19414

The MRI notes degenerative changes and some areas that compress nerve roots. The spinal cord itself is not under duress (“without central canal stenosis.”). The most problematic region is C6-7 where you have nerve compression (“moderate to severe left proximal foraminal stenosis with left C7 impingement”).

See the section on the website regarding cervical nerve symptoms and look up the C7 nerve. If the symptoms match your own symptoms, you might have to consider at a minimum a physical therapy program and an epidural steroid injection. You actually might need surgery if you have continued symptoms or weakness.

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.

[APT]

#19482

Hello, thanks you so much, Dr. Corenman, for your thoughtful and informative reply.

I live not very far from Mayo Clinic and have an appointment to see a specialist in mid-June. Apparently they want me to have further tests before I even see him… CT scan, X-rays, EMG, all of cervical spine. I will have those done on June 14th and then will see him on June 15th.

I do have many of the C7 nerve symptoms, I believe when I look at the symptoms on your great site. I basically have an ache around my left part of the skull, neck, side of neck, top part of shoulder, back part of arm, forearm, and hand. When I test my hand for strength, I still have strength in it, but when I lift things up, I noticed my left arm and arm shake more compared to my right.

I just have an awkward feeling in left arm, forearm, hand… the entire arm/hand feels sort of stiff, like the movement is not as good, very stiff, and achy. I kind of feel like that side of my neck, arm, and hand feel stiff and doesn’t want to move like my right side. I get occasional numbness/tingling in first three fingers. The thing is, I do have carpal tunnel as well so that can’t help matters. But the entire arm thing I know has to be from my neck because I never had this with carpal tunnel before. The weirdness in my hand was never there with carpal tunnel before either. That has been since the neck issues. I almost feel like my thumb feels super stiff when I walk, like it wants to bend away from the rest of my fingers. This definitely scared me. If I didn’t know I had these issues with my neck, I would be scared about an MS or ALS. I am reassured at least that I know the symptoms correlate.

Follow up questions:

1. Do my symptoms fall in line with my MRI?

2. Would you categorize my MRI as far as the compression, stenosis as severe enough to cause symptoms?

3. You mentioned that my spinal cord in itself was not under duress… does that mean I am not at risk for things like paraysis?

4. What is the difference between lateral and central stenosis? Is central stenosis more severe than lateral?

5. If the surgeon does go in to stop the compression, is it an invasive surgery or one that could be fairly easy overall?

6. My body hates anesthesia! After gallbladder my vision was non-existent for one hour! I was so panicked, I couldn’t see! After appendix, my breathing was rapid for about an hour. For my hysterectomy, I ended up having an epidural/spinal and just meds so I could sleep which worked out so much better than general anesthesia. Is it possible that I could get something like that for any neck surgery where I am awake or don’t get the general but am just sleepy?

Thanks so much for your help!

Michelle

[Donald Corenman, MD, DC]

#19484

Your symptoms fall in line with your MRI.

The compression “is in the eye of the beholder” so I am looking at this thru the eyes of a radiologist. Nonetheless, there is “severe” foraminal stenosis so I will assume that the nerve compression is severe.

It is highly unlikely that you are at risk for spinal cord injury based upon the MRI readings.

The central canal is where “the cord lives”. Since there is no significant central stenosis, the cord is not in jeopardy. The “lateral region” is where the nerve lives. You have a report of severe compression to the C7 nerve.

The most probably surgery that will be recommend is an ACDF (anterior cervical decompression and fusion). This is a standard surgery that is generally quite successful and easy to go through.

You would need general anesthesia for spine surgery. The old saying “anyone can do surgery if the patient is sitting still” is important. You do not want to be moving with someone next to your neck vertebra.

Let us know how your consultation works out.

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.

[Donald Corenman, MD, DC]

#19485

Your symptoms fall in line with your MRI.

The compression “is in the eye of the beholder” so I am looking at this thru the eyes of a radiologist. Nonetheless, there is “severe” foraminal stenosis so I will assume that the nerve compression is severe.

It is highly unlikely that you are at risk for spinal cord injury based upon the MRI readings.

The central canal is where “the cord lives”. Since there is no significant central stenosis, the cord is not in jeopardy. The “lateral region” is where the nerve lives. You have a report of severe compression to the C7 nerve.

The most probably surgery that will be recommend is an ACDF (anterior cervical decompression and fusion). This is a standard surgery that is generally quite successful and easy to go through.

You would need general anesthesia for spine surgery. The old saying “anyone can do surgery if the patient is sitting still” is important. You do not want to be moving with someone next to your neck vertebra.

Let us know how your consultation works out.

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.

[APT]

#19488

Hi, thanks so much. I am definitely nervous already about spine surgery with the general anesthesia. But I will cross that bridge when it’s set up and all of that.

Let me ask you this… what if I left the compressed C7 go? What could ultimately happen to my neck/arm/hand if it progressed?

Also, is it possible that Mayo could try even a more minimally invasive procedure to relieve the compression or to date, is the ACDF what you have to do for the pinched nerve?

Thanks! You’ve been a great help.

While waiting for my Mayo consult, I had myself convinced that I could become paralyzed as I wasn’t sure what the difference was between central stenosis and lateral stenosis. You have put my mind at ease greatly. I know my neck’s a mess right now and I hate the arm/hand symptoms but I have great peace of mind knowing the MRI is not indicating central stenosis and the serious end result something like that could bring.

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