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#27005 In reply to: Any advice please |
Your neck is more concerning than your lower back but that back is a close second. You have severe central and foraminal stenosis at C5-6. This will affect the spinal cord and the C6 and C7 nerve e roots. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ to understand central stenosis and see https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C6 and/or C7 nerve compression looks like.
For your lower back, you have degenerative disc disease at L5-S1 with compression of the left L5 nerve root. See https://neckandback.com/conditions/causes-of-lower-back-pain/ for lower back pain and see https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/ to understand what an L5 nerve compression looks like and we’ll start there.
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.#26476 In reply to: I think it's more than a pinched nerve, am I wrong? |With a slip of C5-6, you should always have weight bearing X-rays with flexion/extension views.
You need to describe your symptoms as imaging findings may not correlate with your symptoms. See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/.
Your most significant MRI findings are compression of the C6 nerve (“Moderate to severe stenosis due to uncinate hypertrophy and facet spurring.Right neural foramen: Moderate stenosis due to uncinate hypertrophy and facet spurring”). See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/ to understand what a C6 nerve root problem looks like.
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.#25353 In reply to: MRI Cervical Spine Results |First is that I generally don’t endorse sitting MRIs as they have a lower signal strength quality (image is not as crisp) but we have what we have.
You have at C5-6 some concerning findings.”Neutral sitting imaging: The disc is degenerate with loss of height and there is a broad disc osteophyte which contacts the cord and compresses it and there is a associated high signal change within it. There is a moderate canal stenosis. The disc osteophyte extends more to the left causing a moderate foraminal stenosis”.
You have a bone spur compressing the spinal cord which has created some injury (“associated high signal change within it”). See https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/ to see if you have any symptoms of myelopathy. Generally, you need a cervical surgery to prevent further damage to the cord, most likely an ACDF (see 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.#24044 In reply to: MRI Results from Radiologist |We have a lot of ground to cover. There are many symptoms that point to nerve compression from foraminal stenosis, possible myelopathy from cord compression and some smaller signs that point to rotator cuff impingement syndrome.
First-your neck symptoms that fit with radiculopathy. “I have had pain for about 20 years.I have numbness and aching in my right arm and my handwriting/typing is getting worse and worse. I have definite weakness” and “The pain in my shoulder/neck is greatly relieved with my arm on top of my head”. Also, “I have dull aching pain in my bicep area and on top of my shoulder that gets worse when I write”. All these symptoms are consistant with nerve compression, especially the relief you gain by placing your forearm on the top of your head (Bakody’s Sign).
These symptoms match with your right foraminal stenosis at multiple levels (“C5-6 a moderate right neural formaminal due to disc osteophyte, C6-7 4.5 mm disc osteophyte complex eccentric to the right is present causing moderate central stenosis with AP canal dimension measuring 7.5mm. There is moderate to severe left and moderate right neural foraminal stenosis” and “C7-T1:There is marked moderate right neural foraminal stenosis due to disc encroachment”. Any or all of these can generate the pain you experience with the respective nerves (C6,C7 and C8). The hand weakness could also originate from the C8 root compression.
You could have myelopathy (cord compression) that is causing your instability symptoms (“My feet have felt clumsy for the last year or two. I no longer want to wear any high heel. Flats only. I feel very uneasy on ladders lately”).
Finally, your complaints of “I have constant grinding pain that gets worse when I move my my arm on top of my right shoulder, and into the right side of my neck. I have dull aching pain in my bicep area and on top of my shoulder that gets worse when I write” could be from rotator cuff inflammation or even cuff tear.
You need a good work-up including a thorough physical examination to differentiate your symptoms and then probably selective nerve root blocks to identify the nerve pain generators. Depending upon your shoulder examination, you might need a shoulder MRI. Make sure the neurosurgeon can evaluate the shoulder as well as the neck.
Check the website for individual cervical nerve symptoms and shoulder disorders.
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.#22650 In reply to: Surgery-yes or no? |The shoulder and arm pain most likely are from “pinched nerves” C6 and C7 due to the foraminal stenosis at C5-7. See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/ and https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/.
The leg symptoms could be from a separate disorder in your lumbar spine or from the stenosis of the central canal at C5-7. 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.#22641Topic: Myelopathy, myelomalacia, in forum NECK PAIN |Hello Dr. Corenman,
I am looking for some help. I started out with shoulder pain some time back that just got worse and worse. pain started down my arms and hands and then i ended up with temporary paralasis of my arms. i went to my doctor and he said i had carpal tunnel so he sent me for an EMG. the Neuro said that i did have carpal tunnel but that she thought i also had Cervical Dystonia. my PT suggested a second opinion so i got a new doctor. She sent me to get an MRI and they found this:
The visualized part of the posterior fossa, craniocervical junction, paraspinal soft tissues
are unremarkable. The bone marrow signal intensity is within normal limits. No
significant signal abnormality is seen within the spinal cord parenchyma.C2-3: There is a small central posterior disc protrusion without significant stenosis.
C3-4: There is a broad posterior disc protrusion causing a small ventral impression
upon the dural sac, mildly narrowing the subarachnoid space.C4-5: There is disc space narrowing with posterior endplate spurring, and associated
posterior disc herniation. There is also prominence or buckling of the dorsal ligaments
contributing to severe stenosis of the spinal canal. There is bilateral neural foraminal
stenosis. There is abnormal hyperintensity within the spinal cord parenchyma.C5-6: There is disc space narrowing, and there is a posterior disc herniation more
prominent to the right of midline, compressing the right anterior aspect of the spinal cord
and likely impinging upon the ventral nerve roots. There is moderate stenosis of the
right neural foramen and mild narrowing of the left neural foramen.C6-7: There is disc degeneration with disc space narrowing and a broad posterior disc
protrusion narrowing the subarachnoid space.IMPRESSION:
1. Severe spinal canal and neural foraminal stenosis at C4-5 with spinal cord edema.
2. Prominent right posterior disc herniation at C5-6 and other degenerative changes as
above.My nuerosurgeon told me that if i didnt have surgery that i would be paralized from the neck down. so i had it done. i woke up from surgery and could hardly walk. my legs shook so bad i could not stand, but they sent me home anyway.it took me a month to be able to walk half way normal but the tremors and extreme wide gait on left was still there. at my next post op check up i told the doctors assistant, (who was surgery assistant) about my hands and shoulder pain coming back so he sent me for another MRI.FINDINGS:
The patient is status post anterior interbody fusion at C4-C5 and
C5-C6. The patient has undergone partial corpectomies from the previous study.
The central canal is patent at these levels of surgery, as are the lateral
recesses and neural foramina. There are some changes of myelomalacia involving
the cord at the C5 level, similar to the previous study.There is posterior spondylosis at C3-C4 that is causing thecal sac effacement.
However, the cord is not deformed. The lateral recesses and neural foramina are
widely patent at this level. Similar findings are seen at the C6-C7 level.C2-C3 and C7-T1 demonstrate widely patent central canals, lateral recesses, and
neural foramina. There are no perivertebral abnormalities.IMPRESSION: The patient is status post anterior interbody fusion at the C4-C5
and C5-C6 levels. The central canal and lateral recesses are patent at these
levels. There are some persistent changes of myelomalacia involving the cord at
C5. No significant neural compressive abnormalities are present.i went to a sleep doc and he said i now have Clonus, Hoffman’s Reflex, Hyperreflexia, babinsky, restless leg syndrome, sleep apnea, and wide gait in walking. i dont understand why all of this came on AFTER the surgery when i didnt have it before surgery.
The Neurosurgeons assistant told me that none of my symptoms have anything to do with the surgery and that there is something else wrong with me. I am so confused and scared of everything i have read about these findings. i still cant feel anything in my hands and the pain is excrusiating.
Now after going to have a leg EMG that was negative and xrays of lumbar region that were also negative now they want to send me to a new neurologist to check for Multiple Sclerosis. no one seems to know what is wrong with me.
I have been on cymbalta, and gabapentin with no help, so after all the second checking the leg EMG doc suggested Baclofen. so now i am on that too. It does seem to help the tremors but the pain is still there. can you help at all. -
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