[thebird]

#26983

Hi Dr Corenman

Further update if you wouldn’t mind reviewing. Symptoms are still burning in both legs and adhoc imbalance feeling. Seems to be based on neck movement up and down, experienced sitting or walking.

SSEP passed with no signs of dysfunction of cord with neurologist.

Neurosurgeon ordered a new MRI of cervical spine with contrast (New from the results I provided originally) and main findings below:

Report: the alignment is preserved. There is generalised disc desiccation. There is mild loss of disc height with endplate reactive changes, mainly at c5/6 and c6/7. The visualised posterior fossa structures are unremarkable. The cervico-medullary junction is normal.

At c3/4, there is a minimal osteochondral bar. There is minimal right foraminal narrowing.

At c4/5, there is a mild osteochondral bad. There is mild indentation to the thecal sac.

At c5/6, there is a moderate osteochondral bar towards the left. There is mild flattening of the cord on the left, although CSF is still present posteriorly and there is no appreciable cord oedema. There is moderate left foraminal narrowing. There is minimal right foraminal narrowing.

At c6/7, there is a moderate osteochondral bar. There is minimal flattening of the cord although CAF is still present posteriorly and there is no appreciable cord oedema. There is mild to moderate left foraminal narrowing. There is minimal right foraminal narrowing.

Impression:
– multilevel spondylosis with flattening of the cord at c5/6 and c6/7 , although CSF is present posteriorly and no appreciable cord oedema.

– moderate left foraminal narrowing at c5/6 with possible compression of the left c6 nerve.

– mild to moderate foraminal narrowing at c6/7.

The Neurosurgeon has now ordered a dynamic MRI with neck flexion and extension. He advises I’m experiencing cord compression symptoms however current MRIs are showing no compression in the neutral lay down position.

My physical examinations check out fine from what I understand. No strength or reflex issues which I understand to be common symptoms of cord compression. I just wonder is it possible to have the symptoms I’m experiencing from cord flattening or dynamic compresssion (if it Is even occuring) without the physical signs been present? Evidence of any compression has not been found currently.

Appreciate any input you may have

Thanks

[Donald Corenman, MD, DC]

#27135

SSEPs are generally not worth while as they are only valuable when the patient is under anesthesia. When awake, the signals are so minimal as to be unreadable.Dynamic cord compression is a diagnosis in need of a patient as it is so rare.It would easily be diagnosed by flexion/extension X-rays as there has to be enough vertebral motion to be obvious on X-rays. If the neck is stable on flexion/extension X-rays and there is no compression noted on MRI, you do not have “dynamic cord compression” of the cervical spine

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.

[thebird]

#27136

Thank you for your reply this time of year Dr Corenman. The neck flexion/extension MRI has been completed with no compression evident however the discs further protruding the cord and causing further flattening.

I am a bit stuck with this whole thing now. I get a sensation when moving my neck up and down that lasts a split second that feels like my head is disconnected from my body, along with neck stiffness. I can trigger this by the up and down motion but not left and right. They are sending me to a different ENT once again for further tests.

I have one final question if you don’t mind. Do you think It is possible that the disc protruding my cord causing flattening can produce the symptoms I’m experiencing? My Neurosurgeon said it is possible but rare, hence further tests to rule more out. Really hard position to be in as all tests check out fine, except these discs.

Thanks for all your replies, hopefully I get somewhere in the new year.

Cheers

[Donald Corenman, MD, DC]

#27143

It is very rare but possible that those discs are effacing the cord enough to cause symptoms but I wouldn’t bet on it. I would hate for you to undergo a surgery to remove these protrusions and still have the same symptoms.

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.

[thebird]

#27152

Me too. Thanks again Dr Corenman. I will advise if I get anywhere.

[thebird]

#27343

Hi Dr Corenman

Thank you for your time so far. I am hoping for some advice if you could please

I have since had a spinal tap, another brain mri and another balance expert check me out and still have no answers with worsening symptoms. Tests all come back clear. My symptoms are still burning sensations in both legs (not feet) and a feeling of my head out of sync with my body. The word dizzy does not fit it as it is difficult to explain. It is like propriception briefly where my head loses contact of my body where abouts, so sort of an imbalance but not enough to make me fall as it is only seconds. It occurs with eyes closed showering etc I feel unstable. I can trigger this by sitting in poor posture, (for some reason sitting on the toilet is guaranteed to bring it on, and I think that’s because I’m not supported well on the toilet) also moving head up and down like nodding etc. walking with my head down. At times, my neck will go really stiff when this all occurs also. If I walk down stairs and look down in a semi flexion position, it will occur the whole time until I level out. A big part of me feels that it is something mechanical triggering this symptom but no one can put their finger on it or even identify the issue in my legs. I do not have cord compression as there is still CSF at the back of the cord however the anterior side of cord has flattening at c5 to c7 with no CSF present, as previously discussed.

Everyone seems to be unsure if the cervical cord can do this in the current state but unable to find anything else. my history points to physical injury and this area as having the injury. I did also hear them say my leg reflexes are brisk also.

I’ve had so much ruled out now that it’s either these discs doing some sort of cord dysfunction or I’m at the wrong kind of doctors, or wrong tests been performed. Would you have any suggestions I could mention to my doctors for further testing or how would one proceed in this scenario? I guess it also comes out of your speciality been a spine expert but I’ve noticed you giving helpful advice to people. Obviously I’d like to get the issue identified and treated but not looking good for me at the moment, sadly. My neurologist seems to think it’s my sensory nervous system having an issue but can’t locate what’s causing it.

You run a great forum and it has allowed me to track where I’m up to in this debacle and your added input is so helpful. Thank you again

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