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#19240 In reply to: prev acdf and ADR now pain is worse |
Your symptoms do not seem to be from nerve compression (arm pain, numbness, “pins and needles” and weakness in a dermatomal distribution)-see website under “symptoms of cervical nerve injuries”. Neither do your symptoms see to be derived from cord compression (see cervical stenosis and myelopathy_
Your symptoms are of central neck pain that radiates down to the shoulders. This pain can be derived from degenerative discs or degenerative facets (although nerve compression from the C3-4 level can also cause this type of pain).
The C5-6 disc replacement is a question I have. I generally do not like to use disc replacements with neck pain as the general complaint. It is true that the painful disc is replaced but the degenerative facets are actually more mobilized (more motion) which can increase pain if the facets contribute to pain generation.
Your next step is a pain workup. I would start with facet blocks (see this topic on the website with pain diary). Relief might make you a candidate for rhizotomies (again-website). You also might need discograms to look for discal pain generators.
Good luck!
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.#12189Topic: Parsonage Turner vs. Cervical Stenosis, how to differentiate? in forum NECK PAIN |Good afternoon Dr. Corenman,
I am hoping you can shed some light on this subject for me. I have already had DDD at L4-L5 and L5-S1 with a positive discogram sourcing L4 as cause of pain, so I have researched the spine extensively, but not the cervical region, until recently.
Given that most vehicles have several blind spots, I turned my head to the left in November to check my blind spot and felt a pop, followed by a migraine and neck and scapular shoulder pain. I waited three days, as I frequently get migraines (since age 14, became increasingly worse around 2007) and figured I may have just triggered another one. I went to the ER, the Dr did not examination and only ordered medications to “keep me comfortable”. Two days later, I returned and had a great doctor, who ordered a CT Scan. Readers digest version, I had a migraine in April, they did Ct Scan, advised me I had a pinched nerve and used that scan for comparison. Report states small central disc protrusions C4-C5, vacuum disc phenomenon C3-C4 and C4-C5, multiple levels of osteophytes. Second report outlines disc desiccation, osteophytes and minimal anterolisthesis of C6 upon C7. Was referred to neurologist. He ordered MRI, IMPRESSION:Small posterior disc ossified complex at C4-C5 and C5-C6, resulting in mild left-sided neuroforaminal stenosis at these levels. He referred me to a physiatrist and suggested that I may have Parsonage Turner syndrome, but wrote cervical spondylosis without myelopathy on the order for physical therapy.
To date, the pain has escalated in intensity and spread from the shoulder blade to the collar bone, down the left arm to the wrist and thumb, pointer and middle fingers and also affects the shoulder blade and upper arm in the right side. Most recently, within 5 days, the pain now radiates from my shoulder up my neck to my cheek/jaw bone. Nothing controls the pain, and I have been prescribed Lyrica, Nucynta, Dilaudid (which I believe may not be as effective given that it was the medication given for my migraines every 3-4 months) and diazepam. I have had an epidural injection which provided no relief at all. I barely sleep and when I do, its on a mound of pillows in a recliner bearing all weight on my right side. Mind you, I am petite, I am 5’6″ and weigh 105 lbs, so obesity is not a factor. My left shoulder contacting the back of a chair, or a pillow or the seat of a car while driving immediately generates the burning pain in my left shoulder blade and down to my arm. Holding the steering wheel at 9 and 3 for even 10 minutes makes the pain extremely worse, and I recently drove for 5 hours to pick someone up at the airport. That was a week ago and the pain will not subside, no matter what combination of medications I have tried. The dilaudid does not give me the drunk feeling, and it keeps the migraines at bay, which is why I prefer that, but all it does is take the edge off, maybe from a 9 to an 8 at best.
My question is, given everything that has progressed over the three month period, the failed conservative treatments, the location and intensity, the inability to sleep, the impact on normal daily routine, even though I stretch frequently, do a modified yoga routine, showering multiple times, although the water hitting the back of my neck is excruciating, alternating a heating pad on for 30 minutes then off then use ice for 20 minutes on, then off for 20 minutes then on for another 20 minutes every four hours, and still do housework, dishes, laundry, vacuuming. I am on leave from one job, had to quit another because I can not hold my arms up for 8-10 hours per day and the one job I do still have, I can do one handed thankfully. Could this very well be Parsonage Turner, or could the combination of everything going on within the cervical region from c3-c6 be causing this pain? I have images where I as an average person and not a trained professional am able to see disc matter from the herniations and believe that the chemical reaction may be part of the problem as well.
I will have the MRI/ CT Scan images and will upload them as soon as I can, for now my primary concern was to determine if I could have a permanent issue or if I have some sort of light at the end of the tunnel.
#11962 In reply to: C4-5 Stenosis |First, you have to look at the cervial spine anatomy and see if it matches the current symptoms. I hope you have a solid fusion of C5-7 as a non-solid fusion adds more questions to the diagnosis.
C2-4 have degenerative spondylolisthesis. This condition can cause upper neck pain and headaches. C4-5 has central stenosis and bilateral foraminal stenosis-right greater than left.
Look up the section under “cervical radiculopathy” and “cervical stenosis/myelopathy” to understand what the C4-5 level can cause. Then look at the section under “symptoms of cervical nerve injuries” and focus on the C5 nerve root to get a picture of the potential symptoms this nerve can cause.
Disc replacements work well in the right circumstances but I am not a fan of these with the disorder of central stenosis. Laminoplasty is contraindicated in the presence of degenerative spondylolisthesis.
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.#11557Topic: Cervical MRI reading in forum READING X-RAY, MRI & CT SCAN |Dear Dr. Corenman,
thank you so much for giving your time to this wonderful site!!!
I would like to ask your opinion of my cervical MRI which was done last week.
I have uploaded the images on a Youtube slideshow but I don’t think I’m allowed to post the link here. So I sent it to you via the contact form.A little background –
I’m a 48 year old female.
Diagnosed with Ankylosing Spondylitis in 2010 but I’ve had pain since age 19. My spine is not fused. I have sacroiliac inflammation and enthesitis in many places of my body.
I’ve had neck pain since 10 years. I also suffer from migraines.
Five years ago, a cervical MRI showed bone spurs but no stenosis.
For the past months, I’ve been having tingling and numbness down my right arm into my hand and fingers as well as electrical shooting pains down my right shoulder blade. I also have Carpal Tunnel.
I’m right-handed but I feel I have more strength with my left side.Two weeks ago I had a Nerve Conduction Study and EMG that resulted in mild right median nerve entrapment across wrist/carpal tunnel and mild right C7 radiculopathy. Needle EMG demonstrated chronic denervation along with ongoing reinnervation. Physical examination demonstrated hyporeflexia of the right biceps/brachioradialis muscle stretch reflexes.
The Cervical MRI I just had done reported the following –
C1-C2 Mild degenerative changes present.
C2-C3 No significant central canal or neural foramina stenosis
C3-C4 Right greater than left uncovertebral hypertrophy resulting in mild right neural foramina stenosis.
C4-C5 Diffuse disk bulge and bilateral uncovertebral hypertrophy. These result in mild bilateral neural foraminal stenosis. The ventral thecal sac is effaced and there is minimal cord contact. No cord edema or myelomalacia. No cord deformity.
C5-C6 Bilateral uncovertebral hypertrophy in addition to a diffuse disk bulge. There is moderate bilateral neural foraminal stenosis and effacement of the ventral thecal sac with probable cord contact. No evidence of abnormal cord signal. No cord deformity.
C6-C7 Bilateral uncovertebral hypertrophy resulting in moderate left and mild right neural foramina stenosis. There is minimal effacement of the ventral theca sac by a diffuse disk bulge without cord contact.
C7-T1 No significant central canal or neural foramina stenosis.
Impression: 1. Multilevel degenerative disk disease with disk bulges resulting in cord contact at C4-C5 and C5-C6. No significant cord deformity or abnormal cord signal intensity. 2. Low-to-intermediate grade multilevel neural foraminal stenoses are present bilaterally.
Does cord contact mean some cord compression?
Do I have stenoses with myelopathy?
Finally, is this a progressive situation where, eventually, surgery will be needed?I will be doing an epidural injection and physical therapy. My doctor also gave me a referral to go talk to a spine neurosurgeon.
THANK YOU!!!!!!
Claudia
#11538 In reply to: Facing Surgery AGAIN, Needing Help & Advice on my MRI |In general, MRI findings have to be compared to the symptoms to be valid findings but in your case, this is an exception.
“C4-c5 Moderately large central disc herniation with moderate severe canal stenosis narrowing the canal too 6 mm. There is moderate compression of the cord centrally at this level”. This means that you have a large herniation that is compressing the spinal cord. The canal measures 6mm when a normal canal should measure at least 13mm.
You most likely need surgery for this. A good physical examination should be able to reveal how significant the cord compression is. See the section under cervical spine regarding central stenosis and myelopathy to understand what this could mean.
The C6-7 level has some degenerative changes but probably is not significantly symptomatic.
The lumbar spine has degenerative changes and some nerve compression findings but your symptoms would have to be compared to the images to make some sense of this.
The findings of an enhancing lesion along L2 is probably a finding that was present for a long time. Since it has not changed, it is something you probably do not have to worry about.
You need to see out a consultation by a spine surgeon who can help you to understand what problems you face and can perform an ACDF to the C4-5 level to take compression off the spinal cord.
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.#11517 In reply to: direct cord contact relevant within cervical spine |“Your notation “my last MRI before this one showed the C5-6 disc actually slightly indenting the spinal cord and in this more recent MRI of my neck- I do not see the disc actually touching, yet the spinal cord is more pushed in now then it was last year” is difficult to understand.”
The cervical spine images on the MRI from last December ( not the recent one you viewed ) showed the C5-6 Disc actually making contact with the spinal cord at that level, and the cord itself was slightly indented.
This recent Cervical spine MRI that you were able to view does not show the C5-6 region making actual contact with the spinal cord in that area, however, the spinal cord at C5-6 region looks more deformed / compressed NOW, then it did in last December, and yet the recent images ( the ones you viewed ) do not show the C5-6 disc making contact with the cord.
I just wondered how the spinal cord could look so much more / indented compressed NOW in recent films with no actual cord contact. I hope I explained well.
“If you do have myelopathy, a physical examination would demonstrate long tract signe (hyperreflexia, clonus, Hoffman’s sign, Positive Rhombergs sign among others). You need to see a good spine surgeon for these symptoms.”
I do have hyperreflexia ( no clonus in the feet, but my hands and fingers shale when my wrists are bent – whatever that is? I do not have hoffman’s sign, but a side note- my Father has myelopthy and does not have babinski, or hoffman’s sign ) I definitely have positive rhombergs sign- and also feel vibration, electricity like feeling and weakness in arms and legs. ( I don’t know what that could mean, or where its from- and I understand I could have disequilibrium from inner ear- I also want to mention- a long with this recent cervical spine MRI you viewed, I had thoracic and lumbar spine as well……the Lumbar dictated report said:
Findings:
Thoracolumbar dextroscoliosis is demonstrated. Vertebrae have normal height and marrow signal.T12-L1 level: Disc herniation extends superiorly from the disc space posterior to the T12 vertebra over a distance of 2.1 cm, seen in sagittal T1 #5/11 consistent with large extrusion of the disc
herniation indenting the anterior thecal sac producing mild central stenosis.Axial slices are not available through this level.
L1-2, L2-3, L3-4 levels: No herniated nucleus pulposus or significant central spinal canal stenosis.
The neural foramina appear essentially patent. The facets appear unremarkable.
L4-5 level: Loss of disc hydration. Disc bulge effaces ventral epidural fat indenting the anterior thecal sac. Posterolateral disc bulge in combination with facet arthropathy narrows the neural
foramina.L5-S1 level: Disc bulge effaces ventral epidural fat. Facet arthropathy is noted bilaterally. Neural foramina are patent.
The conus medullaris and paraspinal tissues appear unremarkable.
The cervical spine dictated report said:
Findings:
There is upper cervical dextroscoliosis and cervicothoracic levoscoliosis.Vertebrae have normal height and marrow signal.
C2-3, C3-4 levels: No herniated nucleus pulposus or significant central spinal canal stenosis. The
neural foramina appear essentially patent. The facets appear unremarkable.C4-5 level: Posterocentral disc herniation indents the anterior thecal sac extending across the disc space over a distance of approximately 8 mm, seen in sagittal T1 image #8/13. Neural foramina are
patent bilaterally.C5-6 level: Broad based disc bulge indents the anterior thecal sac producing mild central stenosis and cord deformity. Hypertrophic facets and ligamentum flava indent the posterolateral thecal sac.
Neural foramina are patent.C6-7 level: Diffuse circumferential disc bulge indents the anterior thecal sac. Neural foramina are
patent.C7-T1 level: No herniated nucleus pulposus or significant central spinal canal stenosis. The neural
foramina appear essentially patent. The facets appear unremarkable.
The cord signal, posterior fossa structures and paraspinal tissues appear normalI wish I could get a flex- extension MRI of the cervical spine- because I do feel there is an instability there- but I’m afraid to ask for one……” the neurologist I was seeing who did the EMG’S which were abnormal – the EMG’s he performed himself. he said the upper extremities showed chronic C5-6 radiculopathy…
The lower extremtities showed L5-S1 chronic radiculopathy ( that EMG was before the T12-L1 disc issue as shown in the recent MRI I added the report to here above ) also it showed periphreal neuropathy.
I also wish someone would measure in mm the C5- 6 regions and the stenosis at that level…….I have a plastic mm measuring device and if I knew what points to measure I would …..thank you so much for any further info.
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