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#6486 In reply to: 4-level ACDF |
Dr. Corenman,
Thank you very much for your reply (especially on a Holiday).
I’m in Denver and will actually be in Vail in about a week and half so I will be calling your office tomorrow to schedule a visit. If that is too soon, no matter, I will make the trip to Vail when you are available.
You mentioned that neck extension (bending backwards) can cause increased pain from further narrowing of the foramen. Bending my head backwards (and to the right) causes me the most amount of pain and discomfort.
I think you are spot-on with your assessment that C6-7 is causing the problems at this point. The first Epidural was directly into C6-7 and I didn’t have much relief to speak of. For the second Epidural, they went in under the T1 and then up the right side to the C7 and I had immediate relief and significant relief for a couple weeks. The third (Facet block in the C6-7) didn’t provide any relief. Nothing has been done to the C4-5.
Regarding the C4-5 narrowing, I’m with you that there is a discrepancy between the Radiologist and the Surgeon I saw most recently. That is what is causing me the most concern at this point. I do not participate in activities to put myself at risk, but I’m not certain if I am currently doing damage to the spinal cord at this point or not. I understand that if I get in a car accident or fall, etc. I could have problems, but am I doing damage as we speak? The last surgeon left me with the feeling that I am doing damage right now and it will continue to degrade until it’s fixed. (This may require further evaluation on your part, so I understand if you can’t answer at this point).
Regarding ADR, none of the surgeons mentioned this as an option to me, but I did find out about this as I did some research. I mentioned this to the last surgeon I saw, but since he was recommending a 4-level, an ADR was out of the question. If this is still a possibility, I’m all for looking into it.
I definitely would like to explore tackling the two issues that seem to be the most critical at this point (the C4-5 and the C6-7). I can live with the pain and discomfort (for now), and look forward to meeting you in person for a more thorough examination, but at this point do you think there is reason to be concerned that I’m doing permanent damage to my spinal cord in C4-5 because of the compression? I’d rather not rush into making a decision if I still have some time to explore the best solution.
Thanks again.
Rick
#6484 In reply to: 4-level ACDF |Pain in the right shoulder and arm associated with weakness is typically a nerve root compression syndrome. That is normally from foraminal stenosis. The physical examination is normally very revealing to identify the involved root or roots. Weakness of the deltoid muscle is C5; weakness of the biceps is typically C6 and weakness of the triceps is involvement of the C7 root.
Sensory involvement is along specific dermatomes (discreet patches of skin) tested by a pinwheel. FInally, neck extension (bending backwards) can cause increased pain from further narrowing of the foramen.
Your MRI notes at C4-5 (C5 nerve) “moderate left and mild right neural foraminal narrowing”. If the radiologist has read this accurately, this level has only mild nerve compression on the right so that level is less likely to cause symptoms.
At C5-6 (C6 nerve), the radiologist notes “no significant center canal or neural foraminal narrowing”. If he is correct, that level can be ruled out.
At C6-7 (C7 nerve root), “severe left and moderate to severe right neural foraminal narrowing is seen. There is mild central canal narrowing with effacement of the anterior CSF space”. That sounds like the level of major involvement both with nerve compression and central canal narrowing.
The surgeon you consulted with noted relatively severe narrowing of the spinal canal but that was not noted by the radiologist. The radiologist did note mild to moderate narrowing of the canal at C4-5 but mild at C6-7.
Break the problem down into what is currently causing symptoms and what could cause a potential injury in the future. More likely than not, C6-7 is causing your current symptoms of right arm and shoulder pain. You have had two epidurals at C6-7. Assuming they were specific (the injectionist did not flood the canal and drove the medication up to C4-5), how did you do for the first three hours after the injection (see pain diary on the website)? If you had good but temporary relief, the C6-7 level is causing your shoulder and arm pain. This will have to be addressed with an ACDF or ADR (see website).
The next question is the C4-5 level. If the narrowing is severe (and there appears to be a disagreement between surgeon and radiologist), possibly the level might need to be addressed surgically. If you do not participate in situations that put your neck at risk, (mountain biking, horseback riding, motorcycle riding, etc..) you might be able to live with that level with some mild inherent risk.
If you do put your neck at risk or do not want to live with the risk, two surgeries can be contemplated at C4-5, an ACDF (fusion) or a laminectomy. Based upon the limited information here, you do not need a 4 level 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.#6477 In reply to: Constant Back Pain |Dear DR.,
The Quality of the pain is moderate and never goes away.
Pain is sharp, aching in my back which is constant its at the hips to mid back feels like and expands out from the spine. Leg feels like im being shocked every once in a while in diffrent parts of my right leg that range from the hips to the toes. Every once in a blue moon I will get a very bad elctrtical pain thats in my right hip and that ussually makes me fall to the ground imediatley because of the intensity of the pain.
Yes back does feel better for a couple minutes when i stand up. But sitting it feels the worst and then laying down doesnt feel much better.
Pain Percentage is probly 90% of back and 10% leg
on pain scale its probly a 6 or 7 just because its so annoying.
There is a little bit of weakness in my right leg.
I always catch myself automatically walking on the exterior of my foot instead of the whole bottom.
Ive had back pain in the past probly about 6 years ago for like 3 weeks then it went away that was from a bike accedent. Then I had back pain 2 years ago and that lasted about three weeks that was due to lifting a fridge up into a truck. And this year I got into a dirt bike accedent thats when the pain had started.
Laying down is probly the prolong most comfortable along with ICE :)
Sitting down for more that 10-15 minuters makes more back pain and standing for more than 5-10 minutes makes more back pain.
I walk every day for about 15 minutes periodically through out the day and night.
Back does hurt more when bending and it feels more stiff.
The pain has not gone away since 01/02/2012Pain has changed my life completly I dont do alot of stuff around the house and when i do it has been put off for extended amounts of time. I lay down constantly after work and periodically walk outside for a little bit. but for the most of the time i am laying down. I have given up fishing biking lifting s exual life gaming working overtime vacations.
Before I used to work 70 80 hours in 7 days now im lucky to get 40 in seven days and most weeks I dont I use my vacations.I am a EIT/Survey Technician/Cadd Technician
I no longer go out in the field for my job and im constantly getting up and moving and streching. I had my company get a new chair for me. I use ice at work.Let me know if you need any other info.
Thanks,
Alan#6475 In reply to: MRI results |Your husband does have a significant problem. “Herniated discs at the C5-C6 and C6-C7 levels result in severe spinal canal stenosis with spinal cord compression and frank cervical spinal cord myelomalacia at these levels” is something that needs to be addressed surgically in my opinion.
The spinal cord is compressed and according to the radiologist, is injured from this compression. Myelomalacia is injury to the cord. What happens with narrowing of the canal is that extension (bending the head backwards) narrows the canal even further and pinches the spinal cord. After months or years of this pinching, the cord becomes injured and malfunctions.
In my opinion, he needs surgery and this should not wait too much longer. He should avoid any activity that can put his neck in danger (mtn biking, water skiing, horseback riding, basketball, football or others) to prevent further injury and a potential central cord injury (see website).
It very well might be that he only needs an ACDF at C5-C7 (see website) but a further workup needs to be completed to determine the problem levels. In general, recovery is less problematic than you might think. See the website under “Recovery information by surgery” to understand what recovery is necessary.
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.#6465Topic: interpretation of MRI please help !!!! in forum NECK PAIN |Good morning Sir if you could please interrupt and explain my MRI to me I would greatly appreciate it. I am in severe pain everyday from the back of my skull on the right side shoulders and arm with numbness and loss of grip strength in forearm and hand. I have some minor pain and numbness on left side but right side predominant.
TECHNIQUE: MRI of the cervical spine was preformed using TI and T2 weighted sequences in multiple planes.
FINDINGS:Paraspinous soft tissues: Normal
Alignment: There is loss of normal cervical lordosis. Minimal retrolisthesis of C5 vertebra over C6 is seen.
Vertebrae: Mild degenerative endplate changes and Schmorl’s nodes are seen at few levels. Marginal osteophytes are seen at multiple levels. The certebral body heights are normal.
Discs C3-C3 & C3-C4 & C4-C5 & C6-C7 are dessicated and reveal mild diffuse bulges. They indent the anterior subarachnoid space without any significant central canal or neural foraminal narrowing. The bulges measure approx 2 mm in size.
Disc C5-C6 is dessicated and reveals a small broad based posterior herniation. It indents the anterior subarachnoid space, both C6 nerve roots and causes mild narrowing of the central canal and neural foramina bilaterally. The herniation is approx 4 mm in size.
C7-T1 is dessicated and is otherwise unremarkable
Mild generalized facetal and uncovertebral arthropathy is detected.
Spinal Cord: Normal in thickness and reveals normal signal intensity. No focal area of abnormal signal is detected within the cord. No intraspinal mass lesion is detected.
Impression:
1. small broad based posterior herniation of C5-C6 disc causing mild narrowing of the central canal and neural foramina bilaterally. Herniation measures approx 4 mm in size.
2. Mild diffuse bulge of C2-3 to C4-5 and C6-7 discs without any significan central canal or neural foraminal narrowing. These bulges measure approximately 2 mm in size.
3. Mild generalized facetal and uncovertebral arthropathy.
4. Minimal retrolisthesis of C5 vertebra over C6.Thank you for your help in understanding this. Deb
#6453Topic: trying to understand my MRI in forum READING X-RAY, MRI & CT SCAN |Good morning Sir if you could please interpret and explain my MRI to me I would greatly appreciate it. I am in severe pain everyday from the back of my skull on the right side shoulders and arm with numbness and loss of grip strength in forearm and hand. I have some minor pain and numbness on left side but right side predominant.
TECHNIQUE: MRI of the cervical spine was preformed using TI and T2 weighted sequences in multiple planes.
FINDINGS:Paraspinous soft tissues: Normal
Alignment: There is loss of normal cervical lordosis. Minimal retrolisthesis of C5 vertebra over C6 is seen.
Vertebrae: Mild degenerative endplate changes and Schmorl’s nodes are seen at few levels. Marginal osteophytes are seen at multiple levels. The certebral body heights are normal.
Discs C3-C3 & C3-C4 & C4-C5 & C6-C7 are dessicated and reveal mild diffuse bulges. They indent the anterior subarachnoid space without any significant central canal or neural foraminal narrowing. The bulges measure approx 2 mm in size.
Disc C5-C6 is dessicated and reveals a small broad based posterior herniation. It indents the anterior subarachnoid space, both C6 nerve roots and causes mild narrowing of the central canal and neural foramina bilaterally. The herniation is approx 4 mm in size.
C7-T1 is dessicated and is otherwise unremarkable
Mild generalized facetal and uncovertebral arthropathy is detected.
Spinal Cord: Normal in thickness and reveals normal signal intensity. No focal area of abnormal signal is detected within the cord. No intraspinal mass lesion is detected.
Impression:
1. small broad based posterior herniation of C5-C6 disc causing mild narrowing of the central canal and neural foramina bilaterally. Herniation measures approx 4 mm in size.
2. Mild diffuse bulge of C2-3 to C4-5 and C6-7 discs without any significan central canal or neural foraminal narrowing. These bulges measure approximately 2 mm in size.
3. Mild generalized facetal and uncovertebral arthropathy.
4. Minimal retrolisthesis of C5 vertebra over C6.Thank you for your help in understanding this. Deb
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