[btrippcsci]

#30399

Hey,

I am a 30 Year old male with a Herniated Disc at C5-C6. I have had full body numbness / tingling / burning sensation since September of last year. I notice most of the numbness / tingling / burning sensation when I lay down and prop a pillow behind my head, standing up for a long time, lean my head forward etc.

Tests that were ran:
Nerve study test: Normal
Blood Tests: Normal (B12 was slightly down but was not alarming to the Dr)
MRI Cervical: Abnormal (See Below)
MRI Brain w/contrast: Normal
Medication: Oxycodone, Gabapentin
Prior Conditions:
– 3 Bulging discs at L3/4 L4/5 L5/S1. One of these discs also has a tear in it.
– Lumbar and Cervical Degenerative Disc Disease according to MRI findings.
– The above condition already causes shooting pains down the legs / groin, Constant lower back burning / throbbing, etc. As far as treatment I have been getting a combination of medication and shots / ablations.
– Also, not sure what it is from, I have a very painful area between my right shoulder blade / rhomboid and thoracic spine. Thoracic MRI came back normal but I can Press to the right side of my sternum about an inch above my nipple and have a very sharp pain in my back in the above stated region. Not sure if it is rib related or not.

As far as the Herniated disc in the neck, I have had an injection already to try and help and it had zero effect on the numbness / tingling. The interesting thing is that I don’t necessarily have pain into the neck / arms. I do notice some fatigue maybe in my neck but I am just as strong in the hands / arms. I know usually a herniation at that level may cause some issues with the hands / arms. I do get numbness into the hands / arms all the time, especially when laying down or sitting at my desk typing (I am a software developer). The Herniated disc only seems to be causing full body neuropathy really. It is very annoying when this happens because it puts me in a bad mood, if my newborn slobbers on me it burns, I drop stuff / have difficulty holding on to things when this is occurring etc. It is just not good. Normally I am very conservative and want to avoid surgery just because I worry that at my age (30) if I get any sort of fusion, it is just going to put more pressure above and below that joint and now I will have even more problems. I know the neck is a lot bigger deal than the lower back, I realize that if I were to get into an accident or something, the issue could be more of an emergency.

MRI Findings for Cervical: I am quoting this as it was written in the report. Although some of it seems to be contradictory.

FINDINGS: The sagittal images demonstrate the vertebral bodies to be of normal height, alignment and signal intensity. The intervertebral discs are of normal disc space height. There is slight
loss of disc signal at C4-5 and C5-C6. There is posterior protrusion of disc material at C5-C6 resulting in effacement subarachnoid space. On the sagittal images there is no cord compression. The remainder of the discs are of normal alignment. The spinal cord is of normal shape signal intensity and configuration. The craniocervical junction is normal with no cerebellar tonsillar herniation.

C5-C6: There is a central herniated disc effacing the subarachnoid space. There is slight anterior flattening and splaying of the cord. There is mild narrowing of the central canal with a residual central canal of 9.8 mm. No abnormal signal is noted in the cervical cord. There is minimal narrowing of the left neural foramina from some extension of the disc laterally. The right neural foramen is patent.

Impression
1. Central herniated disc at C5-C6 with slight anterior cord compression.
2. Mild degenerative disc disease

My question is, is surgery something that I should consider giving the MRI findings, as well as my current symptoms.

[Donald Corenman, MD, DC]

#30404

Your symptoms can be consistent with myelopathy but there are other disorders (like Vitamin B12 deficiency) that can cause these symptoms.

The radiological reading of your cervical MRI (“C5-C6: There is a central herniated disc effacing the subarachnoid space. There is slight anterior flattening and splaying of the cord. There is mild narrowing of the central canal with a residual central canal of 9.8 mm”) indicates at least some compression of the cord. Neck position can increase or decrease cord compression as extension (bending backwards) can narrow the canal and flexion (bending forward) can cause the spinal cord to drape over the herniation.

Your symptoms of “I have a very painful area between my right shoulder blade / rhomboid and thoracic spine” are consistent for referral pain from the herniation in your neck.

Part of the work-up is the physical examination. Do your symptoms change with forced flexion or extension of your neck? Do you have long tract signs such as hyperreflexia, Hoffman’s sign or Clonus? Do you have some imbalance findings?

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.

[btrippcsci]

#30407

Do your symptoms change with forced flexion or extension of your neck?
I notice the symptoms more with the flexion almost immediately. If I am standing up without any numbness. and then I lay down and lean my head up like I am trying to do a sit up or a crunch, I almost instantly get the numbness / tingling / icy feeling. After doing this, it tends to last for a while. One of the ways I have learned to relieve it is by laying with my head as straight as possible without any flexion or extension, however, the problem is just minimized.

Do you have long tract signs such as hyperreflexia, Hoffman’s sign or Clonus?
Negative: In the physical work up prior to the MRI the first visit, they did most of the tests you are referring to. They were negative, so they then ordered an MRI of the Brain / Neck. That is when they found the Herniation.

I think they were looking for some sort of trauma or accident. I was rear ended 3 years ago and that is when i started to noticed the upper back / rhomboid pain, It is possible, the herniation or weakening of the disc occurred then, however I did not get any of those symptoms until recently. My lower back problems just progressively occurred as well. There was no one event that I just started to experience pain.

Do you have some imbalance findings?
When I was asked this question at the Dr, I said no because I haven’t noticed it at the time. However, I have recently had moments where I would lose my balance, or have a moment of weakness or something that is rare. I have always been an athlete and have been very sure handed, rarley drop my phone, etc. I have noticed that I have seem to drop my phone more often and randomly lose my balance here and there. I would say though, that the balance and weakness that is or may be occurring is not severe or noticeable to others.

I was golfing while before I went to the Dr finally and I noticed that I hit a couple shots that instantly made both arms go numb. Also, after the round I was walking like normal and both legs essentially gave out for a couple seconds and I struggled to stumble against the vehicle beside me to stop from falling over. In my golf swing, I know I tend to flex my neck during my downswing close to impact and follow through as i am extending through the shot. I will to stand up essentially while both arms are extended with chin on the chest, similar to a baseball swing at impact. This is when I noticed both arms going numb and almost like a shocking feeling on impact.Did not notice this on every shot. Just the ones where I really got on it.

Thanks,
Brandon

[Donald Corenman, MD, DC]

#30410

Normally, intermittent cord compression causing myelopathy will have some tail-tale signs such as long tract findings which are absent. However, some of your symptoms certainly fit with myelopathy from cord draping (“recently had moments where I would lose my balance…notice the symptoms more with the flexion almost immediately…seem to drop my phone more often and randomly lose my balance here and there…hit a couple shots that instantly made both arms go numb. Also, after the round I was walking like normal and both legs essentially gave out for a couple seconds”). Also, the end of your golf swing where “I noticed both arms going numb and almost like a shocking feeling on impact which could be L’Hermitte’s sign.

All in all, I am concerned about you possibly having myelopathy. It would really depend upon your MRI findings and flexion/extension X-rays.

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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