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Hi Dr Coreman

Yes I did have myelopathy as the first surgeon messed me up bad the plate was bent in my neck and was told by the last two surgeons who Fixed that mess up and took the hardware out broken screws they did a corpectomyy with inter body cage from c5-7 than flipped me and did a bilateral laminectomy at c5 and left hemilaminectomy at c6
The MRI exam demonstrates the patient to be status anterior cervical plating at c5-7 level with screw fixation at c5 and c7 levels. The patient is status post corpectomyy with inter body cage spanning c5 through the superior c7 levels. The orthopedic hardware is better evaluated on the patients concurrent ct and prior cervical x-rays. Metallic artifact from the patients hardware obscures fine detail. The patient is also status bilateral laminectomy at c5 and left hemilaminectomy at c6.
New MRI without contrast done in Jan. This year said: there is loss of the normal lordosis. The visualized vertebral body heights are maintained. There is loss of intervertebral disc space height height at c4-c5 and c7-t1 levels. The visualized vertebral body marrow signal is appropriate for the patient’s stated age. No abnormal signal is identified within the cervical cord. The cerebellar tonsils are normal in position. There are degenerative changes at the c1-2 level.
At the c2/3 level there is disc bulg. There is no central spinal cord stenosis or neural for amen narrowing.

At the c3/4 level there is disc bulge eccentric to the right. There are degenerative changes involving the facets bilaterally. There is bilateral neural for amen narrowing.

At the c4/5 level there is osteosarcoma ringing with a moderate-sized central disc herination with extruded disc material extending superiority behind c4 end plate and indenting the thecal sac. There is bilateral uncovertebral joint and degenerative facet disease left greater than right. There also is ligamentum flavum hypertrophy indenting the dorsal aspect of the thecal sac. This combination results in central spinal canal stenosis. There is also moderate bilateral neural for amen narrowing.

At the c5/6 level patient is status post fusion
At the c6/7 level patient is status post fusion
At the c7/1 level there is disc bulg. There is no central spinal canal stenosis or neural foremen narrowing at this level.

Impression patient status post cervical fusion c5-7. Osteosarcoma riding with moderate sized central disc herination at c4/5 indenting the thecal sac with spinal stenosis. Disc bulges at c2/3 c3/4 and c7/1
See the addendum at the top of this report. It may contain additional important information or changes.

Ct scan done same day Jan this year said:
Technique multiple axial sections were obtained from the mid orbits to the sternoclavicular joint. Sagittarius and coronal reformation were obtained from the axial data set. The images were reviewed in soft tissue and bone Windows. 3D reconstructions were obtained on a independent workstation to better asses the cervical hardware.
Comparison MRI cervical spine same day Jan 2018 and cervical X-rays February 2017.
Findings: the ct examination demonstrates the patient to be status anterior plating c5-7 levels with screw fixation at c5 and c7 levels. There is an additional retained right sided screw fragment within the superior portion of the c7 vertebral body and correlation with surgical history is recommended series 80249 image 25 and series 5 image 45. The patient is status post posterior cervical fusion with lateral mass rods spanning c5-c7 levels with interpedicular screws at the c5 and c7 levels. The right sided c7 screw projects along the medial cortex of the pedicel series 5 image 43. The patient is status post corpectomyy at the c5 through c7 levels with a inter body cage spanning the inferior c5 through the superior c7 levels. Metallic artifact from the patient orthopedic hardware obscures fine detail. The patient is also status bilateral laminectomy at c5 and left hemilamilaminectomy at c6.
There is loss of the normal cervical lordosis . The visualized vertebral heights are maintained. There is loss of intervertebral disc space height at the c4/5 and c7/t1 levels. The perverse real soft tissues are within normal limits. There are degenerative changes at the c1/2 level.
Limited evaluation of the orbits demonstrates irregularity of the medial walls bilaterally right greater than left with medial displacement of the medial reclusive muscles bilaterally which appears thickens. This may be secondary to pRevious trauma or surgery and clinical correlation is recommended.
Impression status post anterior and posterior fusion c5 thRough c7 level with internode cage please see comments regarding hardware.
This latest MRI and ct scan were not compared to any prior MRI or ct or the ct Myleogram only X-rays done in February 2017 and MRI and ct done same day Jan 2018.
My symptoms are sever headaches that last days not migraines as it starts from neck into back of head and goes to top and sides, pain down both arms, pain to both shoulders and shoulder blades. I get electric shock like pain down arms more so if I look down. Nick always hurts and feels stiff. Fingers tingle and go numb. Arm strength is weal so is the grip as if opening a jar. Get pain behind eyes when neck pain is bad and the headaches. My handwritten has changed seems to have gotten very sloppy, hard button shirts. I also have bladder and bowel issues. I do also have lower back herination which they had wanted to do a plif on l4-5 but I’m sure you no how comp works and now it’s more levels in the lower back also. I do have a righ rotor cuff part t at f on the d lay in comp doing surgery on the right shoulder and no it’s also has a partial tear, but even before the tear to the right arm I still had pain going don both arms into fingers. EMG done a couple years ago did show something with the nerv s that were fused.
If you don’t mind me asking how would you treat this?? I’m so tired of the headaches, neck pain and stiffness, arm pain and weakness along with tingling and numbness.
When I saw a neurosurgeon and he saw the prior MRI ct scan and ct myl organ he flipp d and wanted to know hat they said when scanning me and saw this he said it was bad and no spinal fluid getting by one level he wasn’t even going to let me leave the hospital but was able to convince him by saying look how long comp took to okay the last surgery hen they knew the plate and hardware were broke they made me wait over a year and h said I remember that and look at the problems we ran into. I do not know hat problem I was told the surgery to longer it was almost 12 hrs I know they had to use a robotic thing to get the bent plate and broken in half screws out, they were surprised after it that I as even able to walk. I said I complained of the leg pains. I know when the dr was not going to let me leave last year that my reflexes were all very hyper both arms and legs. Is there anything besides surgery? I have done the facet inj cations, nerve blocks, radio frequency ablutions any relief was short term.
Thank you so much for your reply. How much to send you the last two MRI and ct scan and Myleogram. I know the cr Myleogram done in 2016 which I have gotten worse since than but I know comp didn’t tell th m what to write for that, my comp adjustor tells the place when I er I have any test done to use low dose only they did that with the MRI to look for a tear they were told low dose only but it did show a tear on the 1.5 strength even though I was told they use a higher magnet when looking for tears. I might pay to have MRI with contrast done. As my primary dr said this last MRI should have been done with contrast since th ct Myleogram showed something with limited spinal fluid getting by one level and a lot of stenosis.
Thanks so much for your opinion how would you treated this?

Well here are the findings, I don’t see anything illuminating but you are the doc. I don’t have access to a scanner so I’ll just type them in.
CT C Spine W Contrast. Myelogram Cervical

HISTORY: Myelopathy, previous anterior and posterior cervical spine surgeries.
Findings: Features of C5-T1 ACDF with partial left-sided corpectomy of C6 and C7 and mature osseous fusion at these levels. Additionally, laminectomy changes at C6 and C7. Hardware is intact. Artifact from hardware limits image detail somewhat. Posterior elements are solidly fused C5-T1 Bulky osteophytic ridging at right C6, otherwise canal is patent. Small disc osteophyte complexes at C4-5 from junctional disc degeneration, and C3-4. Minimal levocurvature. No spondylolisthesis.No abnormal fluid collection or obvious mass within the spinal canal. No evidence for myelomalacia. Soft tissues are unremarkable.

Axial levels:
C1-2: Normal
C2-3: Normal
C3-4: Left central disc ostophyte complex indents the ventral thecal sac, mild stenosis. Facet arthrosis with mild right foraminal narrowing. Patent left foramen.
C4-5: Disc osteophyte complex with bulky right facet arthrosis. Mild narrowing of the spinal canal. Mild to moderate right foraminal narrowing. Patent left foramen.
C5-6: Posteriorly decompressed. Bulky osteophytic ridging narrows the right lateral recess and approximates the ventral right hemicord. Mild right foraminal narrowing. Patent left foramen.
C6-7: Posteriorly decompressed. Canal and foraminal are patent.
C7-T1: Facet arthrosis. Patent canal and foramina.

I don’t know what to think now, I can’t be left like this. It’s like I’m getting used to this semi- functional state and avoiding being up on my feet much and that’s not healthy. It will be at least 2-3 months to get into a neurologist, and that’s with a referral from the NS. I don’t know if this has any bearing but this was done at a teaching hospital and was done by residents , which I don’t care for as I used to have to work with residents. I know they have to learn on the job but….
My sister-in-law is an RN and thinks I should go through an ER to be evaluated and fast-track the referral process to the neuro. It may not work that way I’m afraid. This is a living nightmare. Any thoughts? Still not having any horrible pain other than my neck from the severe muscle strain from trying to keep my head up, getting more difficult as time goes by. Staring to have a lot of discomfort in upper thoracic area between shoulder blades, that’s new in the last week. Arms still feel like they are burning here and there, mainly on the upper outer portion. Bowel issues getting noticeably worse. OMG I need someone to actually examine me and help me. Thanks for your insight.

Hi Dr Corenman
I got struck in back from head to knees had one surgery in 2000 and 2003. It was a work injurymy first surgery comp Dr screwed up his own X-rays said hardware was broke and a question of the fusion but after having the 2nd surgery which was a front of neck approaches and than I was flipped and they did the back of the neck. I was told by the neurosurgeon and orth Dr that did the surgery that the plate was bent in my neck and both fusion were fractured all the way five of the six screws were broke.
Here is a earlier from 2014 MRI
2014
Bone marrow hyper intense signal on the left side of the c4 vertebral body on stir images which was not evident on prior study.
A Ct and bone scan was done to check that and all was fine
Fractures none
Disc height normal at all cervical levels
Ostephytes mild marginal osteophytes vertrally at c4-5
C2-3 no disc bull seen the neural foramonia are patent
C3-4 mild disc bulge with protrusion into the right ventral epidural space without cord deformity. The neural foramina are patent
C4-5 mild disc bulb without cord deformity. The neural foramina are moderately stenotie bilaterally
C5-6 fused level no cord compression is evident. The neural foramina are patent.
C6-7 fused level no cord compression is evident. The neural foramina are patent.
C7-T1 no disc bulg or herination is seen. The neural foramina are patent
Cord no abnormal signal is seen within the cord at any level
Impression: cervical fusion at c5-7
Disc pathology at c3-4 and c4-5 as noted without cord compression
Fora in all stenosis is significant bilaterally at c4-5
Hyper intense signal in the left side of the vertebra body at c4, not evident on the prior MRI scan referenced above . Corrrelation with Ct is recommended to elevate the bony architecture of this lesion. Bone scan is recommended to exclude other such lesions.
Ct scan and bone scan were done no other lesions on bone scan and the Ct scan was a arthritic bone.

Can you give your opinion or advice as this is worker’s comp and I was having MRI done on another body part and was told they had to place me on hold as they had to find a place that dose low dose only, I was like it’s a MRI not Ct scan. So I don’t even now if these are what it really shows as how can some of the stenosis just go away. Should I go to a prepay place and get a new MRI I think it’s 500.00 with contrast and no insurance. Can you tell me how much it is to have you re read these just the MRI from dec 2017 and Ct myleogram 2016 and prior MRI 2014?
i get headaches from back of neck into head, pain down arms along with numbness, weakness and tingling of arms. Had emg done in 2016 which showed one arm c5-6 and the other arm c7-8. My arms and legs will go completely numb where you can not lift or turn palms over it can last up to a hour it happens in both legs also. Saw primary Dr no stoke as it’s both arms both legs. It happens up to twice a month. Comp doesn’t let me see the surgeons, I last saw neuro Dr last feb and he flipped when he saw the films and said he needs new ones but it takes comp forever to get them. Neuro did say over a year ago that he was going to do surgery from the back of neck but that was before this last MRI so does this look like surgery to you and if so what level c4-6. Thanks for any opinions. Your in colerado im on east coast, what do you think maybe I’ll have to take a family trip. I do have bladder and bowel issues but I also have lower back but was told the bladder and bowel was from the neck cervical myelopathy I know I had that before the second surgery which was a double one front of neck and than flipped for 2 no part of that surgery from back of neck.
Thanks in advance for any thoughts.

Thank you Dr. Corenman! I was not aware of the “retraction” injury possibility, I had not previously heard of. While I did not have contrast done with gadolinium in any post-op MRIs, I was given the following as part of the radiologist impressions as a part of 2 follow-up cervical MRIs done post-op, and also a CT scan that I had done when I first felt like something was becoming unstable. I put the snippets of the CT and 2 MRI’s at the bottom of this post.

One of the MRI’s seems to think there is no cord signal abnormality, one doesn’t weigh in on that aspect at all, and the CT scan seems to think everything is stable in terms of the vertebrae, but maybe contrast is needed to confirm signal issue? That said, the snippets below of those exams are a little confusing to me given how I still feel at the site where the surgery was done. If I roll over too fast in bed or my neck gets pressed on there, sometimes I get a rude awakening in terms of those shocks or a numb feeling for an instant in a leg, arm, etc.

My surgeon also did a “just in case” MRI a few days ago on 07 FEB 2018 and basically said, nothing has changed since your last MRI of your neck on 23 JAN. He also did some x-rays, including flexion position x-rays, but they were never even discussed, so I’m hoping that means there’s nothing there of note. Hence the polyneuropathy conclusion on his part and his sending me off.

With that. I am in a position now where I feel like I need to try to keep walking as much as possible rather than continue to lay dormant and afraid to walk around at all (which is what I’ve mostly been doing the past couple of weeks), but at the same time I do not want to hurt myself. To that end, neither my surgeon nor any physicians in the ER here have told me that I am in any immediate danger of serious injury from walking around the house as long as I avoid falling, etc. But it is certainly unsettling to have some of the symptoms I’ve been having the past 2-3 weeks and wondering what I should be doing, and if it is the right thing to stay out of the hospital, though I’ve taken myself to it about 6 times in the past 2 weeks out of a maybe too-healthy abundance of caution.

I am still relatively young and just want to stay on top of these symptoms before they become long term or permanent. I know time is of the essence with a lot of these issues especially if it is myelopathy, arachnoiditis, etc. I still test negative for Hoffman’s and Babinski’s and my gait is able to be totally normal as long as the swelling in my neck is contained before I try to get up. The problem I notice is that if I stand or walk long enough during the past couple of weeks, I feel what I would describe as a pressure / crushing sensation near the site of my neck surgery, and from that moment on, I seem to have about 10 seconds or less to sit down or I’m probably going to have an adverse event (fortunately, it hasn’t ever gotten to that point because I always seem to find a spot to get to by then). That said, even when sitting back down after one of those flare ups, proceeding to dragging my foot slowly across the floor can make my neck surgery site tingle. Or, lifting that same foot even an inch or two off of the floor during one of these flare ups causes pressure / tingling in the neck site as well. It’s bizarre.

While I admittedly haven’t done much rehab to strengthen the area around my neck surgery to this point, I’m not sure if rehab can offset whatever that sensation is, though I find it interesting that it never happened the first 8 weeks post-op. Is this the “retraction” injury possibility?

Every day is getting sort of scary, but every time I go to the ER here locally, I get sent home and told I have no imminent spinal emergency on my hands. That’s been my life the past 2-3 weeks, and while I would of course rather keep hearing that I am OK from every doctor, I don’t want to wait until that is no longer the case for me or them to act.

Is there anything else that could possibly be causing this in the way of “polyneuropathy”? Doesn’t seem to add up, I’m very much inclined to agree with you, Dr. And if you are correct, how would I force an ER to not kick me out? I feel like they are looking at it from an imminent paralysis situation and then ruling that out, and sending me home. I could of course be totally off base on that, but I’m starting to wonder given how many times they and now my surgeon has sent me home.

Thanks so much again for your expertise!

Sincerely,

Lucas C.

SNIPPETS FROM RECENT CT AND MRI RESULTS

From CT scan done 13 JAN 2018:

2. MILD DEGENERATIVE CHANGES OF THE CERVICAL SPINE MORE PROMINENT AT
C5-C6 AND C6-C7. NO HIGH-GRADE SPINAL CANAL STENOSIS OR NEURAL
FORAMINA NARROWING.

“THE VERTEBRAL BODY HEIGHTS ARE MAINTAINED. THE PREVERTEBRAL SOFT
TISSUES APPEAR WITHIN NORMAL LIMITS. THERE IS NO ABNORMAL SIGNAL IN
THE CERVICAL SPINAL CORD. THE VISUALIZED POSTERIOR FOSSA OF THE
BRAIN AND CLIVUS ARE UNREMARKABLE.”

From MRI done 23 JAN 2018:

Cervical vertebrae demonstrate anatomic alignment and normal bone marrow
signal intensity, without fracture or compression deformity..
Craniocervical junction and cervical spinal cord are normal in appearance.
Left hemilaminectomy defect at C5-6 and C6-7 with ill-defined T2
hyperintensity in the left posterior paraspinal soft tissues at this level.
There is trace fluid in the left C6-7 facet joint.