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#36152 In reply to: Cervical Spine |
You have noted “C4-C5, mild to moderate right exit foraminal narrowing and possible right C5 neural irritation….C5-C6, moderate to severe exit foraminal stenosis and probable bilateral C6 neural compression.(Right worse than left)…C6-C7, right sided component indents the right hemi cord severely narrowing the right neural foramen with probable right C7 neural compression.”
This means you have two potential problems, spinal cord compression from C6-7 “indents the right hemi cord” possibly leading to myelopathy (see hyperlink) and nerve root compression of right C4-5 (C5 nerve), bilateral C5-6 root compression (C6 nerve) and C6-7 right root compression (C7 root). Read both hyperlinks to understand potential problems.
https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/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.#35538 In reply to: Fusion Recovery with Fibromyalgia |I didn’t have a CT scan, but here is my MRI report. Current imaging (Feb 2023) is compared with imaging prior to ACDF surgery (Dec 2021). Even though the radiologist said C2-C3 was “severe” (in several ways), he also said it was the same as the imagining prior to surgery. I had different pain prior to surgery but not the problems I’m having now. See what you think. Thank you for your help.
______________________________
______________________________RADIOLOGY REPORT
Spine cervical wo contrast MRI
CLINICAL – M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
TECHNIQUE: Multiplanar multisequence imaging of the cervical spine was performed.
IV CONTRAST: No gadolinium.
COMPARISON: 02/15/2023 radiograph, 12/28/2021 MRI examFINDINGS:
C3-C7 ACDF changes are present. No vertebral marrow or paraspinal edema identified.
Spinal cord: Appears unremarkable.C1-C2: No spinal stenosis or neural foraminal stenosis.
C2-C3: Severe left facet arthrosis with left foraminal osteophytes and severe left foraminal stenosis, similar to prior exam. Ligamenta flava thickening is present without spinal canal stenosis present.
C3-C4: Resolved spinal canal stenosis since prior exam. Severe left facet arthrosis with mild left foraminal stenosis.
C4-C5: Resolved spinal canal stenosis since prior exam. Right facet arthrosis is present with mild right
foraminal stenosis.
C5-C6: No spinal canal stenosis. Bilateral facet arthrosis is present. Moderate left foraminal stenosis due to left foraminal osteophytes.
C6-C7: 3 mm posterior osteophytes with mild spinal canal stenosis and contact with anterior cord margin. Moderate bilateral foraminal stenosis due to left foraminal osteophytes.
C7-T1: Bilateral facet arthrosis with foraminal osteophytes, with moderate left foraminal stenosis. No spinal canal stenosis.IMPRESSION
1. C3-C7 ACDF with resolved or significantly improved multilevel spinal canal stenosis described previously. C6-C7 mild spinal canal stenosis present.
2. C2-C3 severe left foraminal stenosis. C5-C6 moderate left foraminal stenosis. C6-C7 moderate bilateral foraminal stenosis. C7-T1 moderate left foraminal stenosis.#35132 In reply to: Chronic neck pain |You note after the C5-6 ACDF; “After surgery, my feet were worse. They were tingling and numbness constantly for several weeks. Now it’s on and off throughout the day but all my pain and symptoms are worse since surgery. Some of the pain is very sharp. I also had zapping down my spine but that has subsided”. All of your symptoms are non-specific so further description could be helpful. I’ll include a hyperlink noting how to give a good history at the bottom. Normally, myelopathy (problems due to compression of the spinal cord) causes incoordination and paresthesias in the feet but not pain.
The radiologist notes; “appears to be some residual endplate hypertrophy indenting the thecal sac and abutting the cord. This is not as pronounced as the disc protrusion noted previously, is accentuated by the blooming artifact caused by metallic hardware. There is no cord edema or myelomalacia”. This means there is some smaller residual abutment of the cord, but not as bad as before surgery. However, you could have developed a pseudoarthrosis (non-fusion) of the C5-6 level which could leave you with greater neck pain than before. A fine-cut CT scan would be quite helpful to evaluate the fusion, residual compression and will get rid of the “blooming artifact” noted to obscure the image.
https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
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.#35099 In reply to: MRI Result, please advise, do I need surgery? |You don’t give me as much knowledge of your symptoms (“numb feet” and “symptoms in the shoulders”) but I can give you a rundown of what could be occurring. You do have central canal narrowing which could lead to myelopathy (compression and dysfunction of the spinal cord). The shoulder symptoms could be from the shoulders or from nerve compression in the neck (“severe intervertebral foraminal on the right and moderate on the left”)
“At C5-6, moderate vertebral canal stenosis and marked indentation and flattening of the ventral cord but no overt compression or evidence of intra medullary signal abnormality. There is severe intervertebral foraminal on the right and moderate on the left
At C6-7, further moderate vertebral canal stenosis and ventral cord flattening is demonstrated. Again there is no overt compression or cord signal abnormality. Severe right and moderate left sided intervertebral foraminal narrowing is demonstrated.
At C7-T1, moderate to severe intervertebral foraminal narrowing is demonstrated, worse on the right.
No other significant neuroforaminal narrowing or evidence of any compressive radiculopathy elsewhere.
Modest atlantoaxial joint degeneration is noted otherwise the craniocervical junction is normal”.At L3-4, there is moderate vertebral canal stenosis and crowding of the cauda equina roots but without overt compression. There appear to be subtle bilateral degenerative facet joint effusions.
I’ll give you some homework to read about and we can talk after you have a better understanding of what could be going on.
https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/
https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-neck-shoulder-and-arm-pain/
https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/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.#34967 In reply to: MRI Result |You note: “I’m so afraid to go work. I had an episode after a heavy workload. I was profusely sweating, dizzy and weak….I have quite a few of these episodes ever since that day”.
You then note pertinent MRI findings of:
C3-4 Disc osteophyte complex contacting and minimally indenting the ventral margin of the cord to the left of midline. Mild central canal stenosis.
C4-5 Diffuse posterior disc osteophyte complex contacting and mildly indenting the cord with mild central canal stenosis. Mild left foraminal stenosis.
C5-6 Diffuse posterior disc osteophyte complex with left uncovertebral spurring. The complex contacts and mildly indents the cord with mild central canal stenosis. Severe left foraminal stenosis.
IMPRESSION: Multilevel disc osteophyte complexes with mild cord impingement. Small focus of hyperintense T2 signal within the cord at C3-4. probably representing myelomalacia.This means your central canal which houses the spinal cord is too narrow causing cord compression and some injury. This is especially noted at C3-4. You need to be examined for signs of myelopathy and definitely need a spine surgeon’s consultation.
See :https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
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.#34906 In reply to: Myeomalcia (change signal in the cord) |“potential long-term risks of instability and kyphosis. The posterior structures resist flexion and these are removed with surgery”
I m know that (the nuchal ligament it is very important to keep head in neutral position and i read this ligament contact mostly to c1 to c7
So by doing laminectomy in level of c4 or c4 and c5 you not need to damage this ligament.(one surgeon say me this very clearly in ZOOM meeting .
Post laminectomy kiposis Risk high when you doing multi level laminectomy or remove c7 (then you need laminectomy and Fusion.
Also important to see the xr alignment if lordosis (you can enter from posterior)
The second problem of instability ,why this Risk high ?
Because by remove the ligament flavum respond to stability of spine in cervical region.
** What the risk not to do surgery :
Developed more weakness in legs,arms, maybe myelopathy will come
,hard to walking in the future
Conclusions: losses more cells in the cord.
I think cervical central canal stenosis symptomatic quick need to be treat
(You don’t think so also ?(off course u don’t do me Physical examination
So you don’t see this side .Meni
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