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  • amandabu
    Participant
    Post count: 6

    Hello,
    I had a C5 corpectomy with C4-C6 arthrodesis in 9/18 for cervical kyphosis with radiculopathy and myelopathy. These were all upper body symptoms. Right after surgery I developed leg weakness to the point of needing a walker and my arms were still very weak and pain still went down my right arm as before. They did an extensive work up with EMG’s, CT Myelogram, cervical facet injection, . . . I was unable to have an mri due to having a medical device for my bladder for interstitial cystitis. I. Saw a neurologist who looked at my past history from 20 years ago where I had some trauma with losing family members and diagnosed me with functional movement disorder. I got a second neurologist to do another EMG/NCS and he found an abnormality in the NCs showing radiculopathy and suggested I could have cervical myelopathy but would need an mri. I had to wait about 6 -8 months for a new lead wire to come out that was mri compatible so I could have another surgery to have it replaced. Then I could have an mri.
    In the mean time I was diagnosed with this functional movement disorder. I mean no disrespect to anyone who has it, I was going to just go on and work hard and try to get better, but I was given the impression that “this was all in my head”. I was treated with a lot of disrespect by PT/OT and physicians from other disciplines because of this diagnosis.
    I decided to go to the Cleveland clinic for another opinion after getting the mri compatible device. The mri and the Cleveland clinic diagnosed me with cervical myelopathy, pseudoarthrosis, cervical kyphosis below my surgery, congenital spinal stenosis, and cervical cord compression. I underwent a posterior cervical fusion from C4-C7 with rods and pins and laminectomies as C6 and C7. Needless to say I had a rough go of it. I was in rehab there for a month. I am still using a walker and the surgery was in 10/2020. I am Back to square 1 because the neurosurgeon believes I should be much better by now. I am not. I can barely hold my head up after walking 200 ft. I have nerve pain down both arms if I move my arms in a certain direction. I feel like I am walking in quick sand. mRI shows fusion is starting and good placement of hardware. A neurologist cannot find anything on exam, but did bloodwork. The only thing that came back low positive was an RNP antibody index. The ANA was negative as well as the rest of the ENP panel. He has now diagnosed me with functional neurological disorder. I’m devastated. In your opinion, can you think of anything else that would cause my symptoms? I have trouble raising my arms, my hips are week, I can walk now about 235 feet and then I have to sit down and I can barely hold my head up. This is after months of physical and occupational therapy including 2 inpatient stays in rehab. I am trying really hard. I want to get better!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Apparently, you had a significant flair-up or further cord injury after your first surgery. That can happen during surgery as the cord is under significant compression with stenosis and motion or work around the cord can further injure it. This is why you had new symptoms in your legs.

    I am unclear what a “functional movement disorder” is as functional means adaptive or “learned”. Are they saying for have problems with your gait or upper extremity motion not due to a neurological disorder?

    You then needed further surgery (“I underwent a posterior cervical fusion from C4-C7 with rods and pins and laminectomies as C6 and C7”) due to possible incomplete decompression and pseudoarthrosis. This surgery was at the old levels (c4-6) adding one additional level (C6-7).

    After surgery, your symptoms don’t sound like they improved much (“I am still using a walker and the surgery was in 10/2020….I can barely hold my head up after walking 200 ft. I have nerve pain down both arms if I move my arms in a certain direction”). Inability to hold your head up could be from alignment or fusion issues post-surgery or from a neuromuscular issue causing weakness in your neck muscles.

    Do you have current MRI and CT scans of your neck?

    Dr. Corenman

    amandabu
    Participant
    Post count: 6

    Hi Dr Corenman,

    I may have used the incorrect terminology, I was diagnosed with Functional neurological disorder after the first surgery and now again. Another name for this disorder that has been used in the past is conversion disorder. The neurologist cannot find a neurological reason for my symptoms on exam nor on mri. I was under the impression that a person could still have cervical myelopathy even after their spine had been surgically corrected??
    I have pasted a copy of my latest mri below. The neurologist has ordered an mri of my brain to verify I don’t have MS. I was checked for that after my first surgery as well, but he wanted to confirm that it is still negative. I will have the mri in a couple of weeks.

    MRI CERVICAL SPINE WITHOUT CONTRAST,

    04/10/2021 at 1348 hours.

    HISTORY: Spinal stenosis, cervical region.

    TECHNIQUE: Multiplanar multisequence imaging was obtained of the cervical spine on a 1.5 Tesla magnet. Images were obtained without IV gadolinium.

    COMPARISON: MRI cervical spine dated 9/11/2020, cervical spine radiographs dated 3/9/2020, and CT myelogram, cervical spine dated 10/28/2019.

    FINDINGS: Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with a ventral surgical plate, vertebral body screws, prior corpectomy at C5, and vertically oriented strut graft from C4-C5 through C5-C6.
    Additional postsurgical changes of prior posterior decompression and fusion are demonstrated from C4 through C7, with pedicle/facet screws connected by vertical rods, new compared to the prior exams. The surgical hardware would be better assessed on the
    prior CT/x-ray exams. Susceptibility artifact related to the metallic surgical hardware degrades images and limits evaluation of the surrounding structures.

    There is persistent straightening of the normal cervical lordosis. No new abnormalities of sagittal alignment are identified. The vertebral body heights are maintained. The marrow signal is notable for mild endplate degenerative signal changes that
    are most prominent at C6-C7 outside of the postsurgical levels.

    The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No masses or fluid collections are seen in the spinal canal or paravertebral soft tissues. The craniocervical junction is unremarkable.

    Multilevel degenerative changes are identified with diffuse degenerative disc desiccation and disc space narrowing, most prominent at C6-C7 outside of the postsurgical levels, where there is moderate loss of intervertebral disc height (slightly more
    pronounced ventrally).

    C2-C3: Negative

    C3-C4: Negative

    C4-C5: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

    C5-C6: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

    C6-C7: This is a postsurgical level. Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

    C7-T1: Evaluation on the axial images of limited due to the susceptibility artifact related to adjacent surgical hardware. No definite high-grade spinal canal or neural foraminal stenosis is identified.

    IMPRESSION:
    1. Postsurgical changes of prior anterior cervical spine fusion are redemonstrated from C4 through C6, with interval posterior decompression and fusion from C4 through C7. Susceptibility artifact related to the surgical hardware degrades images and
    significantly limits evaluation of the surrounding structures.
    2. Mild multilevel degenerative changes of the cervical spine, without definite evidence of significant spinal canal or neural foraminal stenosis.

    Thank you for your reply. I just can’t seem to believe that my symptoms would be all in my head. It doesn’t make sense to me.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    “I was under the impression that a person could still have cervical myelopathy even after their spine had been surgically corrected?”. That is correct. A cord injury can be lasting and continuous. Surgery is designed to prevent further progression but may not reduce current symptoms.

    The radiologist notes “The cervical cord has a normal caliber. There are no areas of abnormal cord signal. No masses or fluid collections are seen in the spinal canal or paravertebral soft tissues”. This means that the cord has no signs of injury (high signal indicating a scar or myelomalacia indicating a loss of cord mass). This is good news. This doesn’t mean you didn’t injure your cord as microscopic injury may not show up on MRIs but gross injury did not occur.

    What does your examination demonstrate? Do you have hyper-reflexia, clonus or a Hoffman’s sign? What does your walking ability look like?

    Dr. Corenman

    amandabu
    Participant
    Post count: 6

    I still have hyper-reflexia. I do not have Hoffman’s sign. I do not believe I had clonus. I had a “prominent titubation”, “Trace Tromner”, “gait is slow, tremulous distal and proximal activation of legs”

    The neurologist told me I had an Essential tremor?? It showed in my hands, tongue and head.

    I do have muscle spasms/cramps in my neck, shoulders, shoulder blades, diaphragm area and outer hips as well.

    I hope I answered your questions correctly. I couldn’t copy and paste his visit note.

    Thank you!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Signs of cord dysfunction include hyperreflexia but there is hyperreflexia in the “normal” population as well. No clonus or Hoffman’s is a good indication that the cord is “more normal” than not.

    Essential tremors are typical and should not be related to your cord dysfunction.

    Cramping has so many causes that I would have to write 2 pages just to introduce the potential causes (of which myelopathy is only one of these).

    If you still have arm paresthesias, an EMG might help to point to root irritation but with an MRI that indicates no root compression, the potential solutions do not include surgery.

    Dr. Corenman

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