Need a new search?
If you didn't find what you were looking for, try a new search!
-
AuthorSearch Results
-
#28542Topic: C4-C5 Severe Focal Spinal Stenosis in forum NECK PAIN |
Dear Dr. Corenman,
About three months ago, I started to have instantaneous sharp pain in my left lateral elbow and the thumb of the left hand. The pain then developed into the left lateral upper arm and finally the left shoulder. Now I have constant sharp pain in my whole left (lateral) arm from the shoulder to the thumb, but have no pain at my neck. I have got a MRI scan with the following findings.
FINDINGS:
Posterior fossa: The visualized posterior fossa is unremarkable.Alignment: There is retrolisthesis of C4 on C5 [grade 1] on the basis of degenerative disc disease.
Vertebral bodies: Normal marrow signal intensity. The vertebral body heights are maintained.
C1/C2 and C2/C3: No significant abnormality.
C3/C4: Mild posterior disc bulge with mild spinal stenosis and no significant neural foraminal narrowing.
C4/ C5: There is degenerative disc disease with loss of disc height and endplate osteophytes. Moderate concentric disc bulge is present. Disc osteophyte complex causes severe focal spinal stenosis with complete effacement of CSF and indentation of the anterior spinal cord. There is associated increased signal within the central spinal cord, asymmetrically more prominent on the left. Severe right and moderate left neural foraminal narrowing.
C5/C6: Mild posterior broad- based disc bulge without spinal stenosis or neural foraminal narrowing.
C6/C7: Small left paracentral disc protrusion without significant spinal stenosis or neural foraminal narrowing.
The paraspinal soft tissues are unremarkable.
IMPRESSION: C4-5 severe focal spinal stenosis due to degenerative disc disease and concentric disc bulge. Increased signal in the central and left spinal cord due to compression and chronic myelopathy.
Additional degenerative disc disease changes as described above.
My family doctor recommends me to see a neuro-surgeon for a likely surgery.Note that I had a severe flu lasting for over 2 weeks, right before the start of the pain in my left elbow, and I have had no pain at my neck, especially the left side.
I would highly appreciate your advice, would you recommend cervical physiotherapy exercises or surgery or tests for Parsonage Turner syndrome? Looking forward to receiving your reply.
Thanks,
Arq
#28392 In reply to: Strange symptoms and MRI results |You have cord injury that probably caused myelopathy (“C5-C6: There is a moderate right paracentral disc herniation of the extrusion type causing ventral cord abutment and mild spinal canal stenosis with AP dimension of 7.4mm. Associated right paracentral annular disc tearing. Mild increased cord signal at this level, consistent with a degree of myelomalacia”).
This would explain many of your symptoms (see https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/).
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.#28161 In reply to: Cervical Cord Signal Abnormality/Spondylolisthesis L4-L5 |Thank you, Dr. Corenman,
My neurosurgeon showed me the MRI images showing spinal fluid surrounding the cord (although the white spinal fluid on the image looked pretty thin to me). His office notes state: “She does have spinal canal stenosis at C5-6, but with questionable impingement. In fact, on her recent myelogram CT study, there does not appear to be actual cord impingement.” He also stated he thinks there is a reasonable chance that the myelopathy is unrelated to the cervical stenosis. What else could be the cause?
CERVICAL SPINE CT WITH CONTRAST 7/12/17: “C4-C5: There is solid bony fusion across the left facets and the disc space without midline AP canal diameter narrowing. There is severe left and moderate to severe right foraminal narrowing due to residual uncovertebral and facet arthropathy. C5-C6: There is markedly sclerotic very hypertrophic endplate and uncovertebral changes. There is severe bilateral foraminal narrowing, slight retrolisthesis of C5 on C6 and severe disc space narrowing. There is moderate AP canal stenosis. There is some cord flattening/deformity. There is light retrolisthesis of C5 on C6. C6-C7: There is severe disc space narrowing and severe left ucovertebral arthropathy. There is severe left foraminal narrowing, mild right foraminal narrowing but no midline AP canal stenosis.”
You have my heartfelt thanks for your input; over the past three years I have had multiple MRI’s, two myelograms, x-rays and two EMG/NCS studies (EMG/NCS studies were essentially normal) but no definitive diagnosis.
#28154 In reply to: Cervical Cord Signal Abnormality/Spondylolisthesis L4-L5 |With the report of “persistent severe canal stenosis cord compression with focal cord atrophy and T2 signal abnormality at the C5-C6 level” and the presence of myelopathy signs (“slightly brisk reflexes on the left with a positive Hoffman’s sign on the left and 2-3 beat clonus on the left”) and symptoms (“I sometimes have clonus of my left foot. Intermittent pins and needles in left arm with clumsy fingers. I have difficulty walking in a straight line and trouble especially walking on uneven ground”, this seems to be clear cut cord compression with myelopathy. I am unclear why your neurosurgeon does not add up all these factors and consider fixing the C5-6 level. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
This goes the same for the L4-5 level (“There is grade 1 anterolisthesis of L4 and L5 with disc space narrowing and vacuum phenomenon. There is greater right foraminal and lateral disc extrusion with cephalad migration, essentially occluding the right L4-L5 foramen, causing severe foraminal stenosis”). This report goes along with an L4 root injury on the right (“Right Side: sciatica lower back into foot; backache, buttock pain, hypersensitivity of the skin down my thigh, sharp outside knee pain”). You have significant L4 root compression and maybe also L5. See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/
You need to get a second opinion with another spine surgeon.
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.#28137 In reply to: Facet Joint Pain and ACDF Sugery |You have multiple problems in your neck so we will need to go level by level. First, see this section to understand what symptoms each individual nerve root would generate: https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ I’ll indicate the nerve possibly involved at each level. In addition, you have spinal stenosis which could cause spinal cord compression and myelopathy. See this section to understand myelopathy symptoms: https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/
“C3-C4 Normal disc. Mild narrowing of the central spinal canal with an AP sac diameter of 9.5 mm. Uncovertebral hypertrophy contributes to moderate to severe right and mild left neurforaminal narrowing”. Spinal canal here is mildly tight but probably not a big current problem. The nerve roots here are compressed. Look for symptoms especially of the right C4 nerve root.
“C4-C5 Small to moderate sized diffuse disc osteophyte complex contacts and moderately contours the ventral spinal cord and causes moderate narrowing of the central spinal canal with an AP sac diameter of 7.5 mm. Uncovertebral hypertrophy contributes to moderate to severe bilateral neural foramina narrowing”. Here the spinal canal is quite narrowed and myelopathy could be a problem. Also, both right and left C5 nerve are compressed.
What is concerning is that your report from 2016 does not note the significant cord or root compression that is present on your current report (old report:”C4-C5 There is a small posterior osteophyte with minimal ventral thecal sac indentation. The spinal canal is minimally narrowed. Bilateral uncovertebral hypertrophy without significant neural foraminal stenosis”). Here there is no cord compression or root compression noted here. Did you have significant progression in 1-2 years or is this a different radiologist who missed the compression? One man’s mild is another man’s moderate to severe. This is why I hate looking at images through someone else’s eyes.
“C5-C6 Small diffuse disc osteophyte complex contacts and mildly to moderately contours the central spinal cord and causes moderate to severe central canal stenosis with an AP sac diameter of 7 mm. Unconvertebral hypertrophy contributes to severe right and moderate to severe left neuroforaminal narrowing”. Here you have C6 nerve compression bilaterally and cord compression too. Look for C6 nerve involvement and myelopathy.
C6-7 and C7-T1 are not really problematic based upon the report.
Your symptoms could be from C6 nerve involvement as the C5 nerve does not radiate into your hand but does involve the shoulder. Your hand weakness can be generated from the C6 nerve compression or from myelopathy.
If there are discrete findings of facet joint arthritis that can be proved (by facet joint injections) with great temporary relief (see https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/), then a fusion of the degenerative level (ACDF) will relieve pain.
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.#28083Topic: Second Opinion Different from the First? in forum NECK PAIN |By the way…veteran. My neck is killing me. Thank you to anyone who can help me understand what is going on. First doctors minimized pain for years. Long story.
FIRST REPORT 2016:
At C2-C3, subarachnoid spaces are intact without significant central canal or neuroforaminal stenosis. There is right greater than left facet degeneration.At C3-C4, there is a shallow disc bulge with intact subarachnoid spaces. The effective AP canal diameter is approximately 17 mm. Mild left uncovertebral spurring contributes to mild left-sided neuroforaminal stenosis.
At C4-C5, there is a central/right central annular fissure and tiny disc protrusion with intact subarachnoid spaces. No significant neuroforaminal stenosis.
At C5-C6, there is a right central disc protrusion with annular fissure contributing to minimal narrowing of ventral subarachnoid space with an effective AP canal diameter of approximately 10.2 no meters. Mild left uncovertebral spurring contributes to mild left neuroforaminal stenosis.
C5-C6 levels with minimal narrowing of ventral subarachnoid space at C5-C6 without cord flattening or cord signal abnormality. No significant neuroforaminal stenosis.
At C6-C7, no significant central canal or neuroforaminal stenosis.
At C7-T1, there is no significant central canal or neuroforaminal stenosis.
Impression: There is a mild cervical kyphosis centered at C3-C4. Alignment is anatomic. The atlantoaxial and the atlantooccipital joints are within normal limits. The anterior atlantoaxial interval is normal. No focal marrow signal abnormalities are identified. There is intervertebral disc degeneration at C3-C4, C4-C5, and C5-C6 with mild loss of normal intrinsic T2 hyperintense signal without significant height loss. The carotid and vertebral artery flow voids are intact. Visualized structures of the posterior fossa are within normal limits. Soft tissue structures of the neck are unremarkable. Mild cervical kyphosis centered at C3-C4.2. Intervertebral disc degeneration at C3-C4, C4-C5, and C5-C6 levels with minimal narrowing of ventral subarachnoid space at C5-C6 without cord flattening or cord signal abnormality. No significant neuroforaminal stenosis.
LUMBAR MRI: (X-ray was normal study) There is a normal lumbar lordosis. Alignment is maintained. There is preservation of vertebral body and disc space height. >. Cord signal is normal. The conus medullaris is normal in signal characteristics and morphology and terminates at the superior endplate of L2 level. At T12-L1 to L3-L4, there is no significant central canal or neural foraminal stenosis.
At L4-L5, there is radial posterior annulus fissure with an associated shallow broad-based protrusion with mild compression of the thecal sac, causing an effective central canal AP diameter of 10.7 mm. There is mild bilateral neural foraminal stenosis.
At L5-S1, there is no significant central canal or neural foraminal stenosis.
Impression: Shallow broad-based protrusion at L4-L5 with resulting mild bilateral neuroforaminal stenosis. No significant central canal stenosis…Dx of Chronic back pain (SCT 134407002)
Dx of Neck pain (SCT 81680005)SECOND DOCTOR REPORT ON SAME CERVICAL AND LUMBAR MRI + NEW THORACIC (2017)
Cervical MRI: C3-4 C5-6 HNP with mild stenosis. CXR: Mild spondylosis. Reviewed findings with patient. Has disc herniation at C3-4 and C5-6 – but believe C5-6 has greater stenosis an may explain symptoms. In lumbar spine has small HNP and mild stenosis at L4-5.Recommend continue with scheduled Lumbar ESI. If effective – may then also try cervical ESL May also consider further cervical w/u with bilateral UE EMG. Also believe maybe candidate for C5-6 ACDA to provide chance of improving cervical symptoms.
Lumbar MRI: small HNP at L4-5, L5-S1. Mild bilateral recess/foraminal stenosis at L4-5.
Thoracic MRI: Mild Scoliosis1) Dx of Cervical disc herniation with radiculopathy (ICD-722.0)
2) Dx of Cervicalgia (LCD-723.1)
3) Dx of Lumbago (CD-724.2)
4) Dx of Lumbar disc herniation with radiculopathy (ICD-722.10)
5) Dx of Cervical spondylosis without myelopathy (ICD-721.0) -
AuthorSearch Results
