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#6643 In reply to: Surgery fusion |
You do have central cervical stenosis as noted by the radiologist. One of my questions is whether you have symptoms or signs of myelopathy. See the section on myelopathy to see if you fit with any of the descriptions.
You do not note your symptoms in your neck. Do you have neck pain, shoulder pain or arm pain? See the section regarding how to describe your symptoms so I can gain a better understanding of your complaints.
The levels at C3-4 and C6-7 note “mild central stenosis” “Mild” is a descriptor that does not quantify how significant your stenosis is. Is there CSF around the cord at these levels- at least on one side? If there is CSF present, the cord is not significantly deformed by the canal narrowing and and you do not engage in activities that place your neck at risk, maybe you only need the C4-5 and C5-6 levels surgically decompressed.
Your lumbar spine is an entirely different story. We need to keep on track with the cervical spine in this thread as not to confuse individuals reading this. We can address your lumbar spine on another thread.
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.#6442Topic: Myelopathy, MRI, Surgery recommendation in forum NECK PAIN |Dr. Corenman
Almost two years ago I saw my gp for what I described as dizzyness which came in spells and then went away until the next wave. I also complained of “walking into walls” on occasion. He prescribed meclizine for vertigo but after some blood work and a cat scan of the brain knew of no cause. The dizzyness still remains on and off today.
In the following year I suffered 6 or 7 falls, one of which cracked three ribs.
Last June I started feeling my feet burning at night and my legs started hurting and getting weaker. By August the burning reached as high as my butt and the legs continued to weaken to where I complained that it felt like walking was starting to be a chore. Climbing my stairs or simply getting out of a chair was so much harder and I would need help getting up to my feet if I bent down to put something in a cabinet. These problems just get worse through the day and sleep has become no more than nap time.
I saw the gp in September, 2011. I explained the problem and the fact that I also had what I assumed was a piched nerve which shot electric sparks down my right armpit to my elbow, but only occasionally and mostly in bed. and sent me for a nerve conduction study thinking I had neuropathy. The study showed mild axonal sensory peripheral neuropathy. Thus started the ever increasing doses of Lyrica and elavil to treat the burning pain. The drugs prevented fire shooting out but never stopped the burning. The trouble walking, the leg weakness and balance issues continued to worsen.
Around February I thought oh oh, the neuropathy was spreading into my arms as burning and pain began in them in earnest. I saw the gp in April and the gp wondered if that was the cause and ordered cervical xrays. When he received the report back his office called and they had already made the appointment with the orthopedic surgeon.
The orthopedic surgeon took a history, made an exam, especially neurological signs and ordered an MRI. He told me pre MRI I had myelopathy and that my cord was compressed but the MRI would confirm.
This is the MRI report:
No significant abnormalities at c2-3. At c3-4 there is left paracentral disc protrusion resulting in narrowing of the canal. There is also contact of the ventral aspect of the cord on the left without cord impingement.
C4-5: There is subtle flattening of the ventral aspect of the cord on the left due to a left sided disc protrusion and accompanying endplate spurring. There are degenerative facet changes on the right. There is mild to moderate foraminal narrowing, left greater than right due to these factors.
C5-6: There is left sided cord impingement due to a broad based left paracentral disc protrusion with accompanying spurring. Moderate left sided foraminal encroachment due to uncovertebral spurring. Moderate to severe right sided foraminal stenosis due to uncovertebral spurring.
C6-7: There is small right paracentral disc protrusion with mild resulting narrowing of the central canal. No significant foraminal stenosis or facet arthropathy. A small disc protrusion is also noted at C7-T1.
When I saw the surgeon he told me he actually disagreed with the radiologist going as far as to call his report lazy for leaving out measurements. He thought my condition was “much worse” than the report stated. He told me the spine was compressed to 3.72mm at c5-6 and in the other places the diameter was between 5 and 7mm.
His recommendation was ACDF for all discs between c3 and c7. He explained it will never get better on its own and the risk of doing nothing was probably not a good thing. He did not know if the symptoms would get better but without surgery would certainly get worse and with surgery probably will not worsen.
Thanks for your opinion
#5886 In reply to: Cervical Spinal Stenosis? |MRI findings are important but need to be compared to your symptoms and physical examination findings. All the symptoms you note are “Weakness of grip and strength bilateral arm”.
I can tell you what symptoms you could have based upon the MRI findings. You have no real central cervical stenosis per the radiologist so myelopathy should not be present (see website for description). The most significant findings you have are moderate to severe foraminal stenosis on the left of C5-6 and C6-7.
This would cause left arm pain and paresthesias (pins and needles) that radiate down to the thumb and fingers on the thumb side of the hand. You might have a weak left triceps and biceps muscle. You might have problems with strong grip in your left hand. Bending your head backwards (extension) could cause the pins, needles and pain to increase down your left arm.
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.#4982 In reply to: Cervical & Lumbar Radiculopathy |You have mild-moderate stenosis of the cental canal at C5-7. This could cause the beginnings of myelopathy (see website) which could account for your symptoms. Also, simple degenerative disc disease could also yield neck stiffness and shoulder aching. The leg weakness could be from another source including a lumbar spine origin. The physical examination signs I mentioned eariler are associated with myelopathy so if present, could help with that diagnosis.
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.#4447Topic: Cervical Fusion Surgery?? in forum NECK PAIN |My doctor is a neurosurgeon and has advised me that I will need cervical fusion surgery. He said I shouldn’t wait and presently it’s scheduled for 3/31/11. I have NO pain in my neck or arm only some stiffness. I have numbness predominantly in my left arm and less numbness in my right arm and have some numbness and tingling in left and right hands. Please note that I’ve had these symptoms for about 6 years, and I’ve recently noticed the numbness is slowly increasing. The doctor indicated I have 50% compression of spinal cord. Is this surgery the best option for me?? What happens if I don’t have surgery? MRI is as follows: Marked degenerative disc disease changes with moderate to marked disc narrowing at c5-c6 and c6-c7 and large posterior disc osteophyte complex at c5-c6 with underling mild stenosis with ap diameter of the canal between 7-8 mil. There is large hnp at c6-c7 more on the left than right there is also myelopathy at the c6-c7 level sm hnp on right at c4-c5. Mild to moderate spurring to right and left c6 of the uncovertebral joints into the right and left c6-c7 neural foramina and the right and left c5-6 neural foramina. Impression: Myelopathy at c5-6 and c6-7. Mild spinal stenosis at c5-c6 and c6-c7. Large left hnp at c6-c7. Prominent disc osteophyte complex both on right and left at c5-c6. Minimal right disc. Protrusion at c4-c5. Some spurring of the neural foramina as described above.
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