[Nalpasin]

#26542

Dear Dr. Corenman:

I would be very very grateful if you could give me some advice or guidance.

The past 10 months, my SYMPTOMS have been: severe pain in the upper back, pain in the ribs (below the “breast”), at the edge of the rib cage and in the abdominal wall, near the umbilicus. Generally, everything is MORE INTENSE on the LEFT SIDE of the body.

I also have tingling, burning pain and stiffness in my LEFT LEG. It is constant, but intensifies when I begin to walk. Sometimes I feel something like a “small” sciatica, but never numbness.

I have cervical problems too, but the symptoms started at the same time that the upper back pain. The result of THORACIC MRI is: small disc protrusion T6 / T7 paramedial RIGHT that contacts the cord; small protrusion T8 / T9 with lower mass effect.

SIGNS: no babinski, no clonus, no hyperreflexia. Correct temperature balance and perception in legs. Negative somatosensory evoked potentials. EMG of lower limbs negative. All rheumatological diseases are discart. I´m a 40 years old, male.

QUESTIONS: According to the MRI, the T6 / T7 protrusion does not touch the nerve roots, but it makes a very light contact with the cord without deforming it at all, is it possible that my symptomatology comes from there? How is it possible that the symptoms are contralateral? Could the cause be an irritation of the spinothalamic tract?

Thanks in advance,
Best regards.

[Donald Corenman, MD, DC]

#26551

Your thoracic MRI findings no not fit well with your symptoms. Obviously, a small right herniation generally does not cause left sided symptoms. Also no long tract signs (no babinski, no clonus, no hyperreflexia) would also work against a thoracic cord compression syndrome.

You certainly may have lumbar problems as a separate issue (“I also have tingling, burning pain and stiffness in my LEFT LEG. It is constant, but intensifies when I begin to walk. Sometimes I feel something like a “small” sciatica, but never numbness”)

“Severe pain in the upper back, pain in the rib” could be generated by a cervical radiculopathy so an MRI might be warranted there.

Your symptoms of pain “(below the “breast”), at the edge of the rib cage and in the abdominal wall, near the umbilicus” is confusing as the umbilicus is a T10 nerve root and the nipple line is T4 but there is a condition called cervical angina where a C4 nerve can cause anterior chest pain. Possibly a neurologist consultation should be considered for your multi-varied pain complaints but certainly an MRI of cervical and lumbar should be considered.

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.

[Nalpasin]

#26709

Thanks you so much for the response, Dr. Corenman. I really appreciate your helpful orientation.

Best regards.

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