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#11370 In reply to: Spinal Stenosis |
You have had fusions at C5-T1 so those levels are not at significant risk for further cord compression. The risk with stenosis of the cervical spine is myelopathy, the slow deterioration of function of the spinal cord and central cord syndrome, the acute injury to the cord.
In either case, the cause of compression is the already narrowed canal diameter along with extension (bending the head backwards). This maneuver will further narrow the canal and “pinch” the spinal cord.
You don’t note what symptoms were preexisting (the original reason for your three level fusion) and what symptoms are new. If symptoms are stable over the last years after your surgery then the chance of myelopathy progression is less.
Also important is your lifestyle. If you are sedentary (you don’t participate in high level sports) and do not put your neck at risk (mountain biking, contact sports, horse riding, water skiing, etc.), then the risk of central cord injury is less.
Dragging the right foot (foot drop) is not typically related to your cervical spine. There might also be a lumbar spine disorder that could cause that symptom.
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.#11184Topic: C5-C6 myelopathy a "ticking time bomb"?! in forum NECK PAIN |Hello Dr. Corenman,
thank you for taking the time to answer my questions. To give you a brief history of my situation is as follows.
2012 Symptoms: Right side neck & shoulder pain with weak right arm bicep strength.
05/2012 MRI
Broad-based disc bulge with small central extrusion extending caudal to this level creating mild central canal narrowing. Mild left greater than right-sided neural foraminal narrowing.Recommendation: ACDF 2-level,C4-5-6,autograft with plating.
Decision: I was told “it couldn’t get worse”, so I opted to wait. Continued to presume aggressive activities that made things worse.
2014 Symptoms: Same as 2012 but including sever muscle spasms all over body in random locations.
MRI 03/2014
CERVICAL DISC LEVELS:
C2-C3: 2 mm focal central protrusion slightly attenuating the ventral thecal sac without contacting the
cord. No central canal stenosis. No foraminal stenosis.
C3-C4: 2 mm focal central protrusion attenuating the ventral thecal sac, contacting but not deforming
the cord. No central canal stenosis. No facet abnormality or foraminal stenosis.
C4-C5: 2 mm spondylotic disc bulge and osteophytic ridge with mild loss of disc height. Mild
redundancy/hypertrophy of the ligamentum flavum. Mild central canal stenosis. Bilateral
uncovertebral and right facet hypertrophy. Moderate right and mild left foraminal stenosis.
C5-C6: 4 mm focal central protrusion superimposed on spondylotic disc bulge, osteophytic ridge and
mild redundancy/hypertrophy of the ligamentum flavum. Moderately severe central canal
stenosis. Moderate cord compression. Mildly increased cord signal. Moderate bilateral
uncovertebral hypertrophy with moderate bilateral foraminal stenosis.
C6-C7: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
C7-T1: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
CONCLUSION:
1. Large focal central disc protrusion at C5-C6 superimposed on spondylosis with moderate
cord compression and moderately severe central canal stenosis.
2. T2 hyperintensity in the compressed cord at C5-C6 suspicious for spondylotic myelopathy.
3. Small focal central protrusion at C3-C4 contacts the cord centrally but does not deform the
cord or cause central canal stenosis.
4. Mild acquired central canal stenosis at C4-C5.
5. Multilevel facet and uncovertebral arthrosis with multilevel foraminal stenosis, distribution and degree described above.Different Doctor recommendation: C5-6 fusion with carbon cage and non plating. Synthetic graft to promote my own cell growth.
Conclusion: I was told by both doctors if I don’t have this operation I will lose function of my right arm and legs and could be walking with a cane or wheel chair in the near future.
Here is where my dilemma is Dr. Corenman. Since the 2ND MRI I have ceased prior aggressive physical activities that progressed between 2012-2014 and since my pain is now gone. I only feel some tightness between neck and shoulder in the “Spock vulcan nerve pince” area if I am completely inactive. Light physical activity actually makes it almost unnoticeable. My right arm bicep strength has returned to almost 90%. I am no showing any loss of motor skills or reflexes and have perfect balance.
I stuck between a rock and a hard place to make a decision on whether to have the surgery or wait. I told mylothopy doesn’t necessarily have have signs of pain and is a silent killer and is like a “ticking time bomb”. My concern is I have C5-6 done and 10 years later I will have to go again under the knife again because possible adjacent disc issues or I may have more pain due to the surgery itself. I don’t have hardly any pain now so its hard for me to justify going through with surgery.
Should a diagnosis and recommendation for surgery be based on MRI evidence alone? Any insight into my situation would be greatly appreciated.
Chris
#11069 In reply to: C-spine issues months after ACDF- advice needed |You have two separate problems in your neck. These are radiculopathy (pinched nerve) and central stenosis (narrowing of the spinal canal). The treatment you choose depends upon your activity level, type of activity and what risks you are willing to live with.
Your current complaint of shoulder/arm pain (“I began experiencing stabbing pain, aching, & muscle spasms in my trapezius/shoulder area, and down into my left elbow”) is most likely from foraminal stenosis (pinched nerve-see website).
At C4-5, the radiologist reports severe left foraminal stenosis (“uncinate & facet hypertrophy causing severe left & moderate right foraminal stenosis”). This could be causing your current pain but this is pinching of the C5 nerve. This nerve normally radiates pain into the upper arm and not all the way into the elbow.
You can determine if this is the painful nerve by undergoing a SNRB (selective nerve root block-see website). You must keep a pain diary (see website) to determine if this is the pain generator.
The central stenosis is another matter. You have no reported cord problems and there is no signal change noted by the radiologist (“Cervical spinal cord has normal signal”). You do have some risk of cord problems if you take a fall (see central cord syndrome) or you could develop myelopathy (again see website). The risks are greater if you participate in activities that could cause head impact.
If you do not participate in these types of activities (mtn biking, surfing, horseback riding, etc..), your risk is not as great. You can possibly ameliorate your risk by strengthening your anterior neck muscles (SCMs-see neck sit-ups on the website) but this has not been studied.
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.MRIs do not live in a vacuum. You need to correlate the symptoms and physical examination findings to the images to understand what could be causing the pain.
You could have C6 or C7 radiculopathy (nerve root compression-see cervical radiculopathy on the website) or you could have myelopathy (see cervical stenosis on the website) based upon your MRI findings (“Moderate to moderately severe central and foraminal narrowing at C5-C6 and C6-C7 as above”). Look also at “symptoms of cervical nerve injuries” to understand what these nerve roots can cause regarding symptoms.
In the lumbar spine, you might have the beginnings of an isthmic spondylolisthesis, pars fracture or degenerative spondylolisthesis based upon the reading (“left-sided pars irregularity and facet arthropathy/inflammation L5-S1 has progressed from the prior inflammation is more apparent on the current study which includes a STIR sequence”). You can read about these disorders on the website.
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.#10196Topic: cervical spondylotic myelopathy without evidence on scans in forum GENERAL |Dr,
I have been having issues that seem to mimic CSM symptoms after a neck injury, they are progressive. Lost feelings in both arms after injury for short period, buzzing in legs began,severe stiffness of neck, spastic unconnected legs and finger feeling, muscle issues twitching among other things. Dr thought might be MS , scans negative, muscle disorder ( scans neg), now suspect ALS but I know CSM can mimic that with sensory issues and thinking using just common sense I would think injury prior to this progressing would have something to do with it. I have been diagnosed with bilateral carpel tunnel on nerve cond test but pass all the manual testing. As of now my right arm feels dead and it’s hard to stand due to heaviness and I have generalized weakness in both arms and legs. It’s been almost 3 yrs of progression and all conservative measures have failed regarding small herniations that were thought to cause pain but not all other symptoms. All blood work is good. In my heart of hearts I feel it’s my neck and we are missing something. Fibro specialist listed possible myofacial chronic issues but not fibro. Have you seen CSM symptoms without scan correlation? Heading to John Hopkins tommorrow for visit with neurosurgeon. The things for me that seem to mimic symptoms most are ALS, lyme and CSM. CSM seems the most logical because of injury , but scans not there and flexion/extension xrays just show bone spurs, no slippage.
Pre injury MRI results ( from old thoracic problem):
c 2-3 mild foraminal narrowing
c3-4 moderate disc degeneration with biforaminal spondylosisi. Moderate right foraminal and mild to moderate left foraminal stenosis
C4-5 mild to moderate disc degeneration
C5-6 moderate disc degeneration, mild to moderate left foraminal stenosis
C6-7 mild foraminal stenois
C7-T1 good>Post injury
c 2-3 no abnormalities
c3-4 mild degeneration and uncincate joints and facet joints mildly degenerated
C4-5 mild degeneration and 1 mm protrusion
C5-6 Disc space mildly reduced. 2mm posterior protursion eccentric to left. Facet joints mildly to moderatly hypertrophic
C6-7 mildly reduced disc space. 1.5 non focal protrusion
C7-T1 goodRecent thoracic MRI showed possibilty of increased signal intensity at T1 level could be artifactual in nature .
The injury was a child grabbing me from behind in head lock and pulling back and twisting neck towards right side ( was wrestling in pool with godchild)
The choice of surgeries depends upon many factors. Laminoplasty will open the spinal canal but has some risks (as any surgery does). The cord will drift backwards as there is more space for the cord. This cord drift will stretch the nerve roots (as they are obviously attached to the cord) and can trigger a C5 nerve irritation. Most of the time, this irritation fades away but not all the time.
In addition, any nerve root compression originating from the anterior side will not be removed. This condition is called uncovertebral joint hypertrophy-the most common cause of cervical nerve compression (see cervical radiculopathy on the website). The posterior approach can open the nerve hole (foraminotomy-see website) but this can be ineffective to decompress the nerve as this spur projects from the anterior side.
The anterior approach-either an ACDF (fusion) or an ADR (artificial disc), can decompress the cord and any nerve root that is also compressed by the uncovertebral joint spur or a herniation.
Generally, with stenosis that compresses the cord and causes myelopathy, I tend to recommend an ACDF. The canal is already very narrowed and an artificial disc allows motion. This motion can again produce spur formation and a recompression of the cord.
There are circumstances that an artificial disc can be used in spinal cord compression and myelopathy. If the canal is large enough but the herniation is also large, then removal of the herniation will open up the canal and an artificial disc will not place the cord in jeopardy again as the disc will have been removed.
Now-if the entire canal is significantly narrowed and the entire cord could be in jeopardy, the laminoplasty could be indicated. There are even times that both a laminoplasty and an ADCF are required. As you can see, every situation requires a specific plan.
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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