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  • Jonesy
    Participant
    July 21, 2016 at 6:25 am
    Post count: 17
    #22640
    Topic: Myelopathy, myelomalacia, in forum NECK PAIN |

    Hello Dr. Corenman,
    I am looking for some help. I started out with shoulder pain some time back that just got worse and worse. pain started down my arms and hands and then i ended up with temporary paralasis of my arms. i went to my doctor and he said i had carpal tunnel so he sent me for an EMG. the Neuro said that i did have carpal tunnel but that she thought i also had Cervical Dystonia. my PT suggested a second opinion so i got a new doctor. She sent me to get an MRI and they found this:
    The visualized part of the posterior fossa, craniocervical junction, paraspinal soft tissues
    are unremarkable. The bone marrow signal intensity is within normal limits. No
    significant signal abnormality is seen within the spinal cord parenchyma.

    C2-3: There is a small central posterior disc protrusion without significant stenosis.

    C3-4: There is a broad posterior disc protrusion causing a small ventral impression
    upon the dural sac, mildly narrowing the subarachnoid space.

    C4-5: There is disc space narrowing with posterior endplate spurring, and associated
    posterior disc herniation. There is also prominence or buckling of the dorsal ligaments
    contributing to severe stenosis of the spinal canal. There is bilateral neural foraminal
    stenosis. There is abnormal hyperintensity within the spinal cord parenchyma.

    C5-6: There is disc space narrowing, and there is a posterior disc herniation more
    prominent to the right of midline, compressing the right anterior aspect of the spinal cord
    and likely impinging upon the ventral nerve roots. There is moderate stenosis of the
    right neural foramen and mild narrowing of the left neural foramen.

    C6-7: There is disc degeneration with disc space narrowing and a broad posterior disc
    protrusion narrowing the subarachnoid space.

    IMPRESSION:
    1. Severe spinal canal and neural foraminal stenosis at C4-5 with spinal cord edema.
    2. Prominent right posterior disc herniation at C5-6 and other degenerative changes as
    above.

    My nuerosurgeon told me that if i didnt have surgery that i would be paralized from the neck down. so i had it done. i woke up from surgery and could hardly walk. my legs shook so bad i could not stand, but they sent me home anyway.it took me a month to be able to walk half way normal but the tremors and extreme wide gait on left was still there. at my next post op check up i told the doctors assistant, (who was surgery assistant) about my hands and shoulder pain coming back so he sent me for another MRI.FINDINGS:

    The patient is status post anterior interbody fusion at C4-C5 and
    C5-C6. The patient has undergone partial corpectomies from the previous study.
    The central canal is patent at these levels of surgery, as are the lateral
    recesses and neural foramina. There are some changes of myelomalacia involving
    the cord at the C5 level, similar to the previous study.

    There is posterior spondylosis at C3-C4 that is causing thecal sac effacement.
    However, the cord is not deformed. The lateral recesses and neural foramina are
    widely patent at this level. Similar findings are seen at the C6-C7 level.

    C2-C3 and C7-T1 demonstrate widely patent central canals, lateral recesses, and
    neural foramina. There are no perivertebral abnormalities.

    IMPRESSION: The patient is status post anterior interbody fusion at the C4-C5
    and C5-C6 levels. The central canal and lateral recesses are patent at these
    levels. There are some persistent changes of myelomalacia involving the cord at
    C5. No significant neural compressive abnormalities are present.

    i went to a sleep doc and he said i now have Clonus, Hoffman’s Reflex, Hyperreflexia, babinsky, restless leg syndrome, sleep apnea, and wide gait in walking. i dont understand why all of this came on AFTER the surgery when i didnt have it before surgery.

    The Neurosurgeons assistant told me that none of my symptoms have anything to do with the surgery and that there is something else wrong with me. I am so confused and scared of everything i have read about these findings. i still cant feel anything in my hands and the pain is excrusiating.

    Now after going to have a leg EMG that was negative and xrays of lumbar region that were also negative now they want to send me to a new neurologist to check for Multiple Sclerosis. no one seems to know what is wrong with me.
    I have been on cymbalta, and gabapentin with no help, so after all the second checking the leg EMG doc suggested Baclofen. so now i am on that too. It does seem to help the tremors but the pain is still there. can you help at all.

    Donald Corenman, MD, DC
    Moderator
    June 11, 2016 at 2:15 am
    Post count: 8660
    #22367 In reply to: ACDF Post-operative Concerns with CT-Scan results |

    First question would be what were your symptoms prior to the surgery and what changes to the symptoms occurred after the surgery? How has the arm weakness changed since surgery? Do you have any myelopathic symptoms before or after surgery (https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/)?

    There is still compression of the right side of the cord at C5-6 after the ACDF. Comparing before and after images could be helpful to see how this compression has changed. The hopeful news is that I assume there is a fusion now of C5-6 which would mean the cord compression is less problematic. Motion of the segment tends to be the cause of cord injury and if there is a solid fusion, the chance of injury drops.

    At C6-7, there still is foraminal stenosis so this could be causing some right C7 nerve root symptoms. See the section https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what C7 nerve dysfunction looks like. An EMG might not be too effective in shedding light on the nerve problems. See https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies-neck/.

    Revision anterior surgery to remove spurs can be quite successful depending upon the prior surgery undertaken and what grafts were used.

    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.
    lakegirlmn
    Participant
    May 3, 2016 at 8:51 pm
    Post count: 7
    #22095
    Topic: Advised to have ACDF ASAP! in forum READING X-RAY, MRI & CT SCAN |

    Hello Dr.
    My name is Nicole. I am writing to you with hopes you can offer me guidance on how I should proceed/ (schedule a consult with ASAP) seeking a third opinion regarding treatment for my cervical spine issues.

    To quickly summarize, I was advised to have immediate surgery by a neurosurgeon after suffering acute neck pain. I don’t feel comfortable with that recommendation in light of the fact that my symptoms have improved in the 3 weeks since my symptoms first appeared. I had prior neck and back issues over 10 years ago, having been in two car accidents. Overall I haven’t had many neck or back concerns for quite some time. I am a 33 year old single mother of a 14 year old son. I am also moving in less than one month. Proceeding with surgery right now will create many hardships for my son and I.
    If surgery is a must, I will follow through, however I am not comfortable making that decision quite yet, despite still having discomfort, feeling a bit off balance.

    My X-Rays and MRI state the following:

    mri

    Cervical Spine X-Ray:
    COMPARISON: 08/02/2009

    FINDINGS: Multiple views obtained. No fracture seen. Stable reversal of the normal lordosis at C5-6 where there is also loss of disc height.

    There is prominence of the prevertebral soft tissues superiorly which may be projectional. However, if there were a history of trauma, CT could be considered.

    I was seen in consult by a neurosurgeon two weeks ago this Thursday and to my surprise was told I need to have a C5-7 anterior cervical discectomy and fusion as soon as possible. The doctor wanted to schedule surgery to be done immediately. He frowned at the idea of waiting one month, as he felt I would be at risk of having permanent nerve damage. He agreed to two weeks max. He was concerned by my report of feeling slightly off balance, increasingly worse penmanship, urinary urgency, decrease sensation in my left arm and hand sand inability to detect temperature of bath water with my lower extremities (for years) All the aforementioned were not sudden, abrupt symptoms. I had a positive spurlings sign aside from that my reflexes and exam was normal.

    Last Thursday, I saw an orthopedic surgeon who did not feel I was an urgent candidate for surgery as my neurological tests were all normal. He didn’t feel surgery was necessary in his opinion. He reviewed my MRI and X-rays and performed a physical exam. He sensed that I was not comfortable with his opinion, so he advised I obtain a third opinion from another neurosurgeon.

    I emailed the first surgeon and asked if surgery could be avoided as my symptoms have improved. His response was he recommends surgery sooner, rather than later.

    I have surgery scheduled for May 13th. I am employed as a nurse so it is important that I make a decision ASAP! I don’t want to risk permanent nerve damage despite feeling somewhat better.

    It is impossible for me to get a third opinion anywhere before next Friday when surgery is scheduled. I am feeling lost.

    All I want to know is if surgery is inevitable, or do I have other options to stop the “rapid degenerative changes and progression of myelopathy?”

    Thank you for your time
    Nicole

    scjibberja
    Participant
    April 19, 2016 at 10:07 pm
    Post count: 2
    #22022 In reply to: Help explaining MRI results |

    REGION TECHNIQUE: Multiplanar multi-sequence images were obtained through the cervical spine without the use of IV contrast. Standardsequences were obtained. COMPARISON: Plain film of the cervical spine from 03/14/2016 FINDINGS: There is no evidence for compression deformity or subluxation. There are no areas of bone marrow edema. Craniocervical junction is unremarkable. The paraspinal musculature is unremarkable. No areas of abnormal cord signal identified. Flow voids are noted within the vertebral arteries. Multilevel disc desiccation and disc space height loss is noted. This space height loss is most pronounced at C4-C5. There is straightening with mild reversal of the normal cervical lordosis centered at the C4-C5 level. Mild multilevel endplate spurring is noted. There is no prevertebral edema identified.c There is a hemangioma within vertebral body T2. C2/C3: Mild bilateral uncovertebral joint spurring as well as moderate left and mild right facet hypertrophy results in mild to moderate left and mild right neural foraminal stenosis without spinal canal stenosis. C3/C4: Mild bilateral facet hypertrophy and uncovertebral joint spurring resulting in mild left-sided neural foraminal stenosis. There is no spinal canal stenosis. C4/C5: There is disc – osteophyte complex formation with a mild broad-based posterior disc bulge. Mild to moderate bilateral facet hypertrophy is noted. Uncovertebral joint spurring is more pronounced on the left. This results in severe left and moderate to severe right neural foraminal stenosis and mild to moderate spinal canal stenosis with contact of the ventral surface of the cord with mild cord flattening. There is mild increased T2 cord signal intensity within the ventral aspect of the cord best appreciated on sagittal image 7 of series 2. This may represent chronic changes of myelomalacia or compressive myelopathy given the focal cord contact at this level. C5/C6: Moderate right uncovertebral joint spurring and mild bilateral facet hypertrophy result inc moderate to severe right neural foraminal stenosis. There is no spinal canal stenosis at this level. C6/C7: There is a mild broad-based posterior disc bulge resulting in mild bilateral neural foraminal stenosis without spinal canal stenosis. C7/T1: No significant disc bulge, neuroforaminal stenosis, or spinal canal stenosis identified. IMPRESSION: Moderate multilevel discogenic and degenerative changes most pronounced at C4-C5 with mild to moderate spinal canal stenosis, ventral cord contact with mild cord flattening, suspected mild chronic cord changes/myelomalacia, and high-grade neural foraminal stenosis.

    Donald Corenman, MD, DC
    Moderator
    April 17, 2016 at 6:49 am
    Post count: 8660
    #21986 In reply to: Advanced cervical spondylotic changes and congenital cervical canal stenosis |

    Based upon your symptoms and MRI, you could be developing myelopathy. The electrical shocks you experience could be a form of L’Hermitte’s syndrome (cord injury from cervical motion due to stenosis). I worry about your cord signal changes (“Intramedullary abnormal signal is noted along the compressed cord segments opposite C3/4 and C4/C5 discs”).

    Check the section https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ to determine if you have symptoms of myelopathy other than the electrical shocks. You also might have had a mild central cord syndrome with your “history of acute hyper extension injury”. See https://neckandback.com/conditions/spinal-cord-injuries-neck/ and look at central cord syndrome.

    You sound like you need surgery. Going anterior vs. posterior depends upon your neck alignment now, your pathology (how many levels and how much compression) and your physical examination. Either ACDFs or posterior laminectomy or laminoplasty are a two to three day stay in a hospital. The ACDFs require a cervical collar for about a week, give or take and the posterior decompression would be a collar for three weeks. Nine weeks if a posterior fusion is added.

    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.
    Donald Corenman, MD, DC
    Moderator
    March 2, 2016 at 6:56 pm
    Post count: 8660
    #21466 In reply to: Failed cervical fusion and other cervical problems |

    With the report of a radiolucent line at the previous fusion level (“the obvious cleft running completely through the middle of the C6-C7 “fusion”), this is most likely a non-union that is mobile. Since C5-6 has IDR but no right foraminal stenosis and C4-5 (which does have right foraminal stenosis) cannot cause paresthesias (pins and needles” into the hand, most likely you have motion at the previous C6-7 fusion level and have developed foraminal stenosis at this level.

    Myelopathy is much more than “my right hand has some numbness or pins and needles in the thumb to middle fingers, and I occasionally drop things”. I would say the cause of those symptoms is radiculopathy, probably from C6-7.

    So the question is what to do now? You cannot have an artificial disc at an IDR level (C5-6) and cannot have one (in my opinion) at a level with stenosis (C4-5). That means you might be looking at a revision of the ACDF at C6-7 and new ACDFs at C4-6.

    You can test to see if the arm pain is generated by the C6-7 level by getting a cervical SNRB at that level and keeping a pain diary.

    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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