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#31406 In reply to: Severe stenosis and central spinal canal stenosis |
Myelopathy and radiculopathy have to be differentiated. Radiculopathy or compression of a nerve root is concerning but much less so than spinal cord compression. Nerve roots have a much greater capacity to recover than cord compression. You have some possible symptoms of myelopathy (“gait issues and weakness in legs and numbness in toes”) but these are not only exclusive to myelopathy. Your examination is important here to look for long tract signs. Complaints of “chronic fatigue syndrome symptoms” would not generally be attributed to myelopathy.
You do have significant foraminal stenosis “left severe and right moderate foraminal stenosis” at C5-6 and “left greater than right severe foraminal stenosis” at C6-7. This will cause left arm C6 and C7 radiculopathy but your spinal cord compression is only “mild to moderate”. You still might have myelopathy but this is less certain.
I think you probably have some time to see a specialist and 2 months is probably not too long to wait. You could consider a cervical collar to wear part time to prevent your neck from extending which narrows both the foramen and the central canal.
See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/
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.#31312 In reply to: Do not understand results of neck mri |You emote a perfect description of how to manage your symptoms. The symptoms are problematic but tolerable. Your MRI does have some concerning features however.
“C3-4: Posterior broad-based osteophyte/disc complex resulting in cord flattening and moderate central canal stenosis…There is bilateral uncovertebral spurring and facet arthropathy resulting in severe left and moderate right neural foraminal stenosis.
C4-5: Posterior broad-based osteophyte/disc complex flattens the cervical cord greatest on the right, resulting in moderate to severe central canal stenosis. There is moderate to severe bilateral neural foraminal stenosis.
C5-6: Posterior broad-based osteophyte/disc complex effaces the thecal sac resulting in moderate central canal stenosis without significant cord compression. There is bilateral uncovertebral spurring resulting in moderate to severe bilateral neural foraminal stenosis”The foraminal stenosis I am not too worried about. This type of stenosis would cause nerve compression and radiculopathy which you do not complain of. It is the central stenosis that is somewhat concerning. The description of severe stenosis at C4-5 means your cord is in some jeopardy. The spinal canal narrows when your head is extended (bent backwards). If you had a fall impacting your forehead, there is a possibility of a spinal cord injury. With chronic compression, some patients develop myelopathy. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ and https://neckandback.com/conditions/spinal-cord-injuries-neck/ and look at central cord syndrome.
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.#31308Topic: Do not understand results of neck mri in forum GENERAL |Hello,
I am 58 years old (female). I had an injury in 1991 (sign fell on my head with 60 mph winds) with resulting neck fusion in 1994. I no longer live in the state where I had cervical fusion and hard to schedule doctors a ways from where we reside since we live in more rural area. Also, have had more pressing medical issues. Hard to get appts in my state even though we are insured. Over the years, had a few mri’s and have adjusted my lifestyle to continuing DDD. I also have lower back issues with spondylitis, pars defect, some disc bulging, etc. For lower back, I get along with occassional steroidal pads, occasional back brace, an injection 2 years ago, mild exercise and walking daily. Once in a while, my lower back goes out for several days, but I recover.
I am not very well versed in understanding my neck mri results. My neck is in pain quite often, but I have learned to live with it. Causes spasms and subsequent migraines from neck spasms, but imitrex always resolves migraine quite effectively. Neck cracks a lot upon movement. I am careful not to move neck quickly and range of motion is not too bad, considering, but I make do and still enjoy my hobbies. I seem to manage okay with imitrex for migraines, daily walks, wearing a soft brace for longer car rides, occasional traction over door. I had a neck injection about 10 years ago. I do not take any painkillers and cannot tolerate NSAIDS due to tummy issues. Tylonel does not do anything. I am stoic and do okay. Occasional massage helps loosen neck. I keep busy to distract from pain or I am tired from pain and just relax. I can tolerate the pain. I really do not want surgery again, but would if I was at higher risk. This life style has worked for me for several years now. For a couple years, I get numbness on my front right thigh when walking. Doctors cannot explain and think it is possibly Meralgia paresthetica. My Gp concurs. Stretching does help that condition and it is not a problem as I can still walk.
My last mri a couple years ago, I simply do not understand the terminology, even with google. But I get worried I could be at risk and maybe should not continue to ignore it. Can you please help me understand my last MRI? I really appreciate the help.
Here it is:
MR Cervical Spine wo Contrast
IMPRESSION:
1. Multilevel degenerative disc disease, spondylosis and facet arthropathy.
2. Degenerative changes most pronounced at C3-4, C4-5 and C5-6 where there is moderate or moderate to severe central canal stenosis and significant neural foraminal stenosis bilaterally as detailed below.
3. No acute abnormality.INDICATION:
GENDER/AGE: Female,
ORDER INDICATION: R29.2:Abnormal reflexTECHNIQUE: A magnetic resonance imager was used to acquire T1 and T2-weighted images in the sagittal and axial planes. The exam is technically adequate.
COMPARISON: 11/4/2016
FINDINGS: Alignment is normal. There is solid bony fusion of the C6 and C7 vertebral bodies. There is spondylosis throughout the cervical spine, with moderate to severe disc height loss at C3-4, C4-5 and C5-6. There is multilevel facet arthropathy.
There is no fracture identified. No prevertebral fluid collection or edema. Cervical cord shows slightly prominent central canal, as well as snake eyes appearance with punctate T2 hyperintense foci in the ventral aspect of the cord at the C6-7 level,
most likely related to compressive myelopathy.Findings by level:
C2-3: No central canal or neural foraminal stenosis. No disc protrusion or extrusion.
C3-4: Posterior broad-based osteophyte/disc complex resulting in cord flattening and moderate central canal stenosis similar to prior exam. There is bilateral uncovertebral spurring and facet arthropathy resulting in severe left and moderate right neural
foraminal stenosis.C4-5: Posterior broad-based osteophyte/disc complex flattens the cervical cord greatest on the right, resulting in moderate to severe central canal stenosis. There is moderate to severe bilateral neural foraminal stenosis.
C5-6: Posterior broad-based osteophyte/disc complex effaces the thecal sac resulting in moderate central canal stenosis without significant cord compression. There is bilateral uncovertebral spurring resulting in moderate to severe bilateral neural
foraminal stenosis.C6-7: Solid bony fusion with no central canal stenosis or neural foraminal encroachment.
C7-T1: No central canal or neural foraminal stenosis.
#31248 In reply to: POST OP HARDWARE PROBLEMS |To recap your history: “So i had the ACDF on C5,6,7 like i was told i needed. It did not give me any feeling back in my legs or feet! I found that all i could feel was big time pain in my arms and hands. I couldn’t hold anything without dropping it. I was still having incontinence. I was a mess. The Dr didn’t care to answer my questions. 2 days after the surgrey after my brother felt my left legg, he freaked out because it was ice cold. He told my nurse and they sent me to have a ultra sound on the leg. I had a DVT in my calf AND a pulmonary embolism in both lungs! Still paralyzed”. I am unclear why you lost sensation and strength in your leg but the cord could have been compressed causing myelopathy”. See this: https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
“93 days in the hospital then to inpatient rehabilitation to try and learn to walk again”. I assume a rehab hospital.
“In May 2017 i had my 2nd ACDF” and “My pcp ordered a MRI. It showed a large broad based disc ( bone spur ) stabbed right between my spine and C3..After this surgery, it was way wrong immediately after surgery”.
“M<lle recent aurge,y at the upper two levets, with lack or fusion at the C3-4 interspaoe and loosening along the &crew&. The right side screw has backed out ol the plate slightly. other levels show adequale bony fusion”. It sounds like you have had a non-union of C3-4 with instrumentation failure (not uncommon).
“I go back and he tells me that the last fusion didn’t work”. He sounds correct.
Your new MRI notes; “The cord has normal signal. C3-C4: A broad-based diffuse posterior disc-osteophyle complex present. This causes narrowing of the neural foram1na particularly on the nght Mild to Moderate cord nattenlng is present. C4-C5: Mild postenor 061eophyte lormabon is present and causes mild cord attenuabon antEt,or1y”. C5-6 and C6-7 sound to be fused and “OK”.
You then note; “He did call and tell me that i still needed to have him remove HW, REDO C3-4 ACDF and he still needed to go in posterior as well as anterior in order to make sure the plate is fastened down properly in order to hopefully obtain a successful fusion”. With the screw protruding and the level not fused, one of the ways to gain a successful fusion is to go in front and back to get enough fixation to get this level to fuse.
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.#30789 In reply to: HELP!!Cervical stenosis with Central Canal Stenosis HELP!! |History: “10-2002 did a fusion revision at C5-6 with allograft, plate and screws. 2007 started having arm pain and weakness again. did a c6-7 discectomy posterior. April 2019, I fell out of our camping trailer. Arm and shoulder blade started hurting on the left”. My feet got tingly after walking. if touched on pinky toe side. Unsteady on feet stumble. Like Foot doesn’t pick up got worse.
Radiological review
C4-5; “spurring is causing moderate bilateral foraminal narrowing.
C6-7; “thecal sac measures 9-10mm in AP diameter at the midline. The spurring is causing mild bilateral foraminal narrowing”.Some of your right neck and shoulder pain symptoms could be from the foraminal stenosis at C4-5 radiating into your shoulder. You can help diagnose this radiculopathy by a selective nerve root block at C4-5 right with a pain diary. See https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/, https://neckandback.com/treatments/diagnostic-therapeutic-neck/, https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.
Your imbalance and symptoms of foot drop could be from the lumbar spine or from myelopathy (compression of the spinal cord) See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
The physical examination can help to differentiate these conditions.
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.#30650 In reply to: Please help me understand my MRI |Your bladder complaints; “I have also lost my bladder I had no idea that it was coming and I couldn’t stop it. This happened 3 separate occasions” This could be overflow incontinence due to spinal cord compression (myelopathy). Your leg complaints “My left calf and foot go numb out of the blue I can’t feel it causes me to lose my balance” certainly could be myelopathy.
Your arm complaints “The pain is in my neck center and left side. I get pain down spine and in shoulder into my bicep (severe) my four fingers get numb. Sometimes I can’t pick anything up with my left hand because fingers are so numb. I get burning down arm to my fingers sometimes. Sometimes it’s I get electric shock like pain down arm” sound to be radiculopathy due to nerve root compression. All these symptoms fit with the findings “Acquired stenosis most prominent c4-5 through C6-7 with cord flattening and prominent left sided nerve root compromise at both c5-6 and c6-7″.
I would say you need to find a spine surgeon very soon who can assess you and develop a surgical plan to decompress your cord and nerve roots.
See:
https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and
https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ and
https://neckandback.com/treatments/anterior-cervical-decompression-and-fusion-acdf/”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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