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  • mharbison
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    Post count: 5

    Hi Dr Corenman,

    I am having chronic, severe pain in my neck, radiating down my right arm and thumb and index finger. I am also having weakness and numbness and tingling in those areas as well. I seem to be finding that the drs that I see are not really wanting to go any further than steroid injections or radio frequency ablation therapy, which I have already done MANY times to no avail.
    Here is my current Myelogram and MRI that was just recently done. I have not seen the Dr since the scans, but was wondering your thoughts on this. I have had both a lumbar and cervial fusion as well as a foraminotomy.

    MYELOGRAM WITH CT CERVICAL, LUMBOSACRAL SPINE: 6/4/2021
    CT CERVICAL SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
    CT LUMBAR SPINE WITH CONTRAST WITH MYELOGRAPHY: 6/4/2021 10:00 AM
    MYELOGRAM SEDATION: 6/4/2021 10:00 AM
    HISTORY: Previous neck and low back surgeries. Persistent neck and back pain.
    COMPARISON: ARA MRI of the cervical spine 05/24/2021. ARA MRI of the lumbar spine 05/13/2021.
    TECHNIQUE: The risks, benefits, and alternatives to myelography were explained to the patient who understood
    and agreed to proceed. Signed consent was obtained.
    Using sterile technique and local anesthesia, the tip of a 27-gauge spinal needle was placed within the spinal canal at
    the L2-L3 level under fluoroscopic control. Contrast was instilled and maneuvered into the regions of interest. Total
    contrast administered on date of service: 13 ml Omnipaque 300 – Intrathecal.
    Multiple spot and overhead films were obtained. The patient tolerated the procedure well and was sent to CT where
    multiple axial sections were obtained through the areas of interest. Images were viewed both in bone and soft tissue
    windows. Multiple coronal and sagittal reformations were viewed as well. Utilization of dose lowering technique that
    included adjusting the mA and/or kV to protocol and/or patient size.
    Fluoroscopic Dose Area Product (uGy*m2): 1066.7
    OBSERVATIONS: The cervical myelogram images show tiny anterior extradural defects between C2 and C6. The
    right C6 nerve root sleeve is asymmetrically effaced. Both C5 nerve root sleeves are partially effaced.
    The lumbar myelogram images show a small anterior extradural defect at the L1-L2 level.
    The lumbar nerve root sleeves are normally and symmetrically filled.
    Mild C5-C6 posterior listhesis is probably related to facet degeneration with subluxation. When allowing for
    physiologic motion at the C3-C4 and C4-C5 levels, there is no indication of cervical instability when comparing
    flexion and extension standing lateral radiographs.
    Lumbar alignment is normal. There is no indication of lumbar instability when comparing flexion and extension
    standing lateral radiographs.
    There is no indication of bone destruction or acute fracture.
    The anterior hardware stabilizing the C6 and C7 bodies is well-positioned without evidence of loosening or failure.
    Solid interbody fusion has been achieved. The posterior elements of C6 and C7 are partially fused on both sides.
    The anterior and posterior hardware stabilizing the L5 and S1 levels is well-positioned without evidence of loosening
    or failure. Bilateral L5 pars defects are noted. The posterior elements of L5 and S1 are not fused at this time.
    The L5-S1 disc prosthesis is associated with solid interbody fusion.
    There is no indication of discitis, osteomyelitis, arachnoiditis, or epidural abscess.
    C2-C3 disc: Normal. Uncinate spurring produces moderate bilateral foraminal encroachment.
    C3-C4 disc: Normal. Uncinate spurring produces moderate right and mild left foraminal encroachment.
    C4-C5 disc: Slightly narrowed. Minimal posterior protrusion of disc material approaches but does not deform the
    anterior surface of the spinal cord. There is ample CSF posterior to the cord at this level. Mild to moderate bilateral
    foraminal encroachment is noted.
    C5-C6 disc: Mildly narrowed. Posterior protrusion of disc material approaches but does not deform the anterior
    cord surface. A small, right posterolateral disc herniation is best seen on images 63 and 64 of series 4. The right C6
    nerve root is probably compressed as it enters its neural foramen.
    C6-C7 level: No canal encroachment. Facet overgrowth produces minimal right and mild left foraminal
    encroachment.
    C7-T1 disc: Normal.
    T11-T12 disc: Posterior annular bulging slightly flattens the anterior thecal sac but does not deform the anterior
    surface of the distal spinal cord.
    T12-L1 disc: Normal.
    L1-L2 disc: Moderately narrowed. Left posterolateral protrusion of disc material is associated with early marginal
    spurring. The left anterior thecal sac is indented. There is no foraminal encroachment.
    L2-L3 disc: Normal.
    L3-L4 disc: Normal.
    L4-L5 disc: Normal. Early facet degeneration is noted without significant foraminal or canal encroachment.
    L5-S1 level: No foraminal or canal encroachment. Mild listhesis produces early bilateral foraminal encroachment.
    IMPRESSIONS:
    1. Routine postsurgical appearance at the L5-S1 level with solid anterior fusion.
    2. No new disc herniation or significant canal narrowing at any lumbar level since 05/13/2021.
    3. Routine postsurgical appearance at the C6-C7 level with anterior and posterior fusion.
    4. A small, right posterolateral C5-C6 disc herniation probably compresses the exiting right C6 nerve root.

    MRI CERVICAL SPINE WITH AND WITHOUT CONTRAST: 5/24/2021
    HISTORY: Cervicalgia with radiculopathy, right upper extremity, for two years. Spinal stenosis, history of two
    surgeries, arthrodesis status.
    COMPARISON: MRI-08/18/2018.
    TECHNIQUE: Appropriate pulse sequences were employed in multiple planes. Total contrast administered on date
    of service: 9 ml Gadavist – IV.
    FINDINGS:
    General Comments: Again seen is artifact related to hardware used for anterior fusion at C6-7. Cervical vertebral
    body heights are within normal limits.
    Alignment: There is mild reversal of normal cervical lordosis centered at C4-5 which has progressed. There is no
    significant listhesis.
    Cord: No evidence of a mass or intrinsic T2 signal abnormality. After contrast, there is no abnormal enhancement.
    Craniocervical Junction: The cerebellar tonsils are normally positioned. The regional osseous anatomy is within
    normal limits.
    C2-C3: Uncovertebral hypertrophy bilaterally is causing moderate foraminal stenosis, similar to the prior. Patent
    canal.
    C3-C4: Uncovertebral hypertrophy bilaterally is causing mild to moderate right and mild left foraminal stenosis,
    similar to the prior. Patent canal.
    C4-C5: Uncovertebral hypertrophy bilaterally is causing mild to moderate bilateral foraminal stenosis, similar to the
    prior. Patent canal.
    C5-C6: Shallow dorsal disc/osteophyte complex with posterior annular fissure is present along with mild bilateral
    uncovertebral hypertrophy. Mild right and minimal left foraminal stenosis is similar to the prior. The canal dimensions
    remain adequate.
    C6-C7: At this postsurgical level, the canal and right foramen are patent. There may be mild left foraminal stenosis,
    not significantly changed.
    C7-T1: Patent canal and foramina.
    Other: The paraspinous soft tissues are within normal limits.
    IMPRESSION:
    1. Anterior fusion changes at C6-7 are redemonstrated. Mild left foraminal stenosis is suspected, similar to
    08/18/2018.
    2. Multilevel bilateral foraminal stenosis from C2-3 through C5-6 as detailed above, similar to 08/18/2018.
    3.Reversal of normal cervical lordosis has mildly progressed compared to the prior. No significant listhesis.

    Thank you in advance for all your help and advice. You have helped me get through the last 6-7 years in the midst of all of this.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8018

    “I am having chronic, severe pain in my neck, radiating down my right arm and thumb and index finger”. This could be from a C6 or C& nerve problem. I won’t spend time on the lumbar spine today.

    Your CT myelo notes:
    “C4-C5: Uncovertebral hypertrophy bilaterally is causing mild to moderate bilateral foraminal stenosis, similar to the prior. Patent canal.
    C5-C6: Shallow dorsal disc/osteophyte complex with posterior annular fissure is present along with mild bilateral uncovertebral hypertrophy. Mild right and minimal left foraminal stenosis is similar to the prior”.
    C6-C7: At this postsurgical level, the canal and right foramen are patent. There may be mild left foraminal stenosis, not significantly changed”.

    Well, unless you have a chronic injury to your C7 nerve root, the C6-7 surgical level (I assume an ACDF here) should not be causing your current symptoms. C5-6 is a likely culprit as the C6 nerve will radiate down to the thumb and index finger. C4-5, while it wont radiate into the hand, will radiate into the shoulder and cause deltoid weakness (lifting the arm up to shoulder level).

    A selective nerve root block test to determine the affected level is in order. See:
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/ and
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

    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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