Archives

Here are MRI results. Sounds like contrast would have been helpful, which I suggested but was told not necessary:

“Persistent left paracentral disc eccentricity at L4-L5 level likely represents the discectomy site. There appears to be residual central disc extrusion at L4-L5 level. In addition soft tissue attenuation at the left lateral recess cannot be fully characterized without postcontrast imaging. As mentioned above could represent evolving granulation tissue versus residual/recurrent migrated disc fragment.

Left laminotomy at the L4-L5 level is present. There is a residual central left paracentral disc eccentricity which could represent the discectomy site. Intermediate signal in the left lateral recess is of unclear etiology. Postcontrast images would be helpful to distinguish between postsurgical changes/evolving granulation tissue versus recurrent or residual migrated disc fragment.

Moderate disc space narrowing at L4-L5 level is stable. The remainder of the discs preserved at height. The vertebral bodies appear normal in height and marrow signal characteristics.

At T12-L1, L1-L2, L2-L3 level the central canal and the neural foramina are patent.

At L3-L4 level the central canal and the neural foramina are patent.

At L5-S1 level there is suggestion of bilateral L5 pars defect and stable mild anterolisthesis of L5 on S1. The central canal and the neural foramina are patent.

The conus medullaris appears normal in signal intensity and morphology. It terminates at upper L1 level.”

Does residual mean something left behind from the original surgery or does it refer to new herniation?

Any questions you would suggest for my neurosurgeon?

Incoordination and Numbness
• Are there now some noticeable problems with coordination and walking? Hard to say because I’ve always been a klutz. I trip sometimes, particularly walking up stairs. My coordination isn’t good but it never has been.
• Do you find yourself unbalanced when you walk? no
• Do you “misstep” unintentionally much more than you use to do? On stairs, yes
• Do you have trouble keeping your balance in a pitch black room? A little
• Has your handwriting changed? no
• Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button? yes
• Do you find lightening type electrical charges down your spine if you tilt your head backwards? no
• Have your bowel and bladder function substantially changed in association with any of the above symptoms? no
Onset and Length of Time Symptoms Have Been Present
• How did the pain start? I’ve always had neck pain and headaches that I attributed to muscle tension. The more severe neck pain started in January and has been progressively getting worse.
• Was it a gradual onset over years or was there one specific activity or injury that caused it? I don’t’ know if there was something in particular that triggered it in January.
• When did that injury occur? Don’t know
• Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually? It came on gradually
• How long have the symptoms been present and have they changed in quality or intensity? The more prominent symptoms have come on over the last few months. The intensity seems to have stabilized.
• For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe arm pain that radiates down to the hand?
Activities
• What activities increase or reduce the pain? Turning my head side to side or up and down makes the pain worse. Sitting and standing for long periods make the pain worse. Laying on my side with a pillow under my head provides temporary relief. I need to switch positions every 20 minutes or so to keep the relief.
• Think carefully about this question as the information produced is very valuable. Is it sitting that increases the pain where standing reduces the pain or visa versa?
• Can you sit for 15 minutes or one hour before you have to get up? How far can you walk? I get up every 20 minutes or so to get relief. I cant walk for very long. Maybe 20 minutes before I’m need to laydown on my side.
• Does prolonged exposure to the activity cause more pain? yes
• What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain? They all make the pain worse.
• Does the activity cause different symptoms? No, just more intense discomfort.
• Does the neck hurt with sitting and bending but the arm hurt with bending the head backwards? no
• Does the neck pain become worse with bending forward vs. backwards? no
• Does raising the arm cause pain or does it relieve pain? neither
• What does overhead activity do? Makes it more uncomfortable
• Does sleeping relieve the pain or does the pain wake you at night? Sleeping relieves the pain. Sometimes I will wake because of pain.
• Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague? Running, or any activity that requires turning my head side to side or up and down
• Does daily function go relatively smoothly unless you lift something up? no

Symptoms
• Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles? I have pain in my neck and at the base of my skull. It is always there. Either dull or more prominent ache which gets to a point of causing nausea. It spreads up the back of my head and on the sides of my ears. I feel pressure as though someone is strangling me. I get a strange sensation in my neck when I swallow – not pain but feels a little constricted.
• Does the quality of pain change with activity? The pain gets worse as the day goes on regardless of what I am doing. Sitting and standing make it progress faster.
• Is the skin hypersensitive to touch? no
• Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand. no
Percentage of Pain by Location
• What is the percentage of pain in the neck vs. shoulder and arm? 60% neck 30% base of skull and 20% from the inside of the elbow down to the wrist. My wrists become painful when I hold things and they are weaker than they used to be. For example, I cant take a baking pan out of the oven with one hand anymore. Its very painful and my wrist strength won’t support it.

Intensity of Pain
• Pain started at a zero in January and progressively got worse over the last few months. It ranges from a 1 usually in the morning to a 5 in the evening every day. Only once I had a pain that went to an 8, it was a about a month ago. The pressure in my head was so severe I debated going to the hospital. The pain in my lower arms and wrists is only when I use them and it’s a 3.
Weakness
• Is there weakness associated with the pain? The weakness occurs only in my wrists and forearms. I get a numbness down my left leg into my pinky toe occasionally. I’m not sure what triggers it.
• Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)? I don’t feel like any muscles are weak. It seems like its neuropathic weakness. I am extremely clumsy with my hands also.
• Is there now an inability to lift the arm due to pain or to weakness? no
• Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle? Just my forearms have limited strength with pain.