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#4822 In reply to: Disc Prolapse C4/C5 |
Your MRI findings are not your diagnosis but the physical disposition of your neck. You note acute pain in your neck and shoulders. How would you differentiate your neck versus shoulder pain? Is it 50% neck and 50% shoulder pain or more in the neck or shoulder? 60/40, 80/20, 30/70 neck versus shoulder. The percentage of pain from right to left can be helpful.
Do you have any tingling (paresthesias) in your arms or hands? Does the neck pain or shoulder pain become more intense when you bring your head up to neutral versus keeping it bent forward?
The MRI report notes a “bulge” at C5-6 “indenting” the thecal sac. Does this also compress the spinal cord? I would assume not but I don’t necessarily always believe what the radiological report states. You do have C5 nerve root compression according to the report. This would cause pain to radiate into the top of the right shoulder and possibly cause deltoid weakness (weakness with lifting up the arm at the shoulder). Bending your head backwards would cause further compression of this nerve root and more pain. In contrast, keeping your head bent forward will relieve some root pressure and consequently, there will be less pain.
Difficulty swallowing food is normally not associated with neck disorders unless you have developed a bone spur so large that it presses on your esophagus (very rare- I have seen only one case in my career).
Depending upon the correct diagnosis- if you really suffered from C5 nerve compression and had no significant deltoid muscle weakness, you could consider an epidural steroid injection or selective nerve root block (see website for discussion of these) along with some physical therapy. If that was not effective, an ACDF (anterior cervical decompression and fusion) would be the next step.
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.By your description, you have severe axial low back pain. I will have to assume that you have done everything you can to relieve your pain including an extensive rehabilitation program, chiropractic program, epidural injections and medications. I will also assume nothing has worked to relieve the pain and the pain has significantly affected your life and activities.
If the above assumption are true, you might be a candidate for surgery. Surgical repair might be a simple TLIF fusion of the L5-S1 level (see website for details) but that depends upon the condition of the L4-5 disc. You will need to see a competent spine surgeon for that discussion.
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.#4796Topic: L5-S1 herniation in forum BACK PAIN |Hi Dr. Corenman,
I am a female, 45 yro, now 50 lbs. overweight (was slighty overweight prior to injury)
I incurred a work-related injury lifting (twisting at waist) a heavy patient some time ago (2.5 years ago). I had a annular tear and herniation of L5-S1. After conservative treatment, I returned to work for 6 months and had second injury to L4-L5 (herniation). I had conservative treatment, including 3 epidurals, high dose NSAID daily. I was doing well with the NSAIDS until I developed a gastric ulcer, 2d to NSAIDS) I was not able to tolerate pain meds. due to the adverse side effects (nausea, dizziness,hypotension, and disassociate mental state).I was formerly a very active person and enjoyed my occupation very much. A friend had an L-5-S1 fusion due to spondylythesis and has returned to being a firefighter/Paramedic. His successful return to work inspired me to hope to return to work (same occupation).
My spinal surgeon gave me poor odds of returning due to the two disk injuries. He suggested a fusion and a synthetic disk.
As long as I am not active (walking, driving); the pain is tolerable. But this is not living! Only existing. Activity increases pain up to an 8/10, and radiates to buttock, thigh. Pain mostly across lower back and right hip. Herniation was on the right.
The other concern is driving: Pain increases with driving and I feel as though there is crepitus when I get out of the car-I feel relief of the pain and pressure upon standing. I had a diskogram, and now the area of L3-4 is uncomfortable-they injected dye in this disk, as well.
So, my question is: am I unrealistic in hoping to return to work as a Paramedic and my formerly very active life?
Thank you for any response and thank you for your website, it is very informative.#4785 In reply to: Prolapsed discs at C3/C4 and C4/C5. |Based upon your discussion of the presence of spinal cord compression, you need to get a consult from a spine surgeon. Make sure your physical therapist understands the ramifications of spinal cord compression so he or she does not perform any extension therapy to your neck.
I would be happy to review your films. You can send them on a DVD/CD to my office. Please call (970) 476-1100 and ask for one of my nurses, Diana or Sarah.
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.#4772 In reply to: Prolapsed discs at C3/C4 and C4/C5. |There are many different diagnoses that could cause your symptoms. Visits to an emergency department are not typically helpful for accurate spinal diagnosis. The emergency room physician has to cope with so many potential fatal diagnoses that an accurate spine diagnosis is not expected.
The MRI reading of “C3/C4 and C4/C5 disc prolapse” also does not describe what your condition is from. Are these herniations that compress the spinal cord? Do these hernations compress one nerve root or more? Are they disc tears/bulges that don’t efface any neurological structure? Are these segments in kyphosis (a reversal of the normal cervical lordotic curve)?. Do the flexion/extension x-rays note instability? As you can see, the MRI report is incomplete.
Whenever I see the diagnosis of “whiplash injury”, it tells me that the diagnosis is incomplete. Whiplash is a generic term for a flexion/extension injury to the neck but does not delineate what structures were damaged. What did the whiplash do? Did this force tear a capsule of the facet, tear a disc, cause a herniation, tear a supraspinous ligament or an insertion of a muscle.
Your symptoms could be from spinal cord involvement. You need to evaluated by a spine expert. A full history, examination and review of all studies needs to be performed.
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.#4770Topic: Prolapsed discs at C3/C4 and C4/C5. in forum NECK PAIN |Hello doctor, I was diagnosed at the emergency department in June this year with disc prolapse at C3/C4 and C4/C5 (MRI and CT scans). It is now mid-August.
Since, I’ve visited emergency department doctors twice, and orthopedics clinic once and didn’t receive any useful advises other than to try not to take a fall or impact. From researching in my own time, it appears this type of injury needs to be managed and not left alone. I’m hoping you can give me some advices.
To give you a quick background information.
CAUSE: Injury during impact sport (impact to the back)
DATE OF INJURY: June, 2011
MRI scan: C3/C4 and C4/C5 disc prolapse. No follow up MRI since.
CT scan: No fracture on C-spine or dislocation
NECK: Gap for spinal cord at C3/4/5 is also narrow by structureDISCHARGE SUMMARY: Whiplash injury, neck pain, bilateral hand(s) numbness and paresthesia. Weakness in arms and hands.
I was told to re-visit a doctor or emergency unit at a hospital if any negative changes occur. Also that it was okay to do light exercises to keep my back strong (though C3/4/5 are in the neck?). The paresthesia in my hands was completely gone after 2 weeks. Less than a week later after I did a back exercise (dumbbell fly – 5kg – bent knees and whole back tilt forward) I returned home to find myself with paresthesia again!
PARESTHESIA: At about a scale of about 5 and alternating.
AREAS: Parts of hands, arms, fingers, feet, arms, thighs.
OTHER: Triceps muscle spasm, predominantly on left triceps.I visited emergency unit and the doctor tested my hands and legs coordination, balance, scratch / pricking test with a stick and blunt needle, reflex tests. Then sent me home saying the same thing, not to take on impact sports again. But like last time, no advises to for proactive treatment, physiotherapy, or any treatment advises at all!
About a week ago, while laying in bed I experienced very intense pins and needles (and weakness in limbs) to the point of it being painful without touching. On all my four limbs and found it difficult to ignore and go to sleep. Tilting my neck too much to the left will also send a fairly strong deep muscle pain down from neck to mid fore arm on my right hand (my doctor dismissed it as muscle and not nerve related and ignored this..).
Please help! It seems all the doctors here are telling me is to go home and don’t move much for the rest of my life!
I’m now only doing sets of short and slow pushups and walking to keep my body in healthy state. The pins and needles now come and go, but I don’t know if that’s because I’m not really doing anything physical or because it is healing. My grip strength is good when testings happen but when I get pins and needles outside, my hands are weak again. My family wants me to catch a flight to see them, is this dangerous?
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