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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8660
    #32803 In reply to: C4-c6 disc buldge |

    You have degenerative disc disease of the C4-5 and C5-6 levels (somewhat common) without reported spinal cord or nerve root compression. There is no report of the facets (again-somewhat commonly missed) which could demonstrate some unrecognized degeneration. You would need X-rays including flexion/extension views to discern motion, stability and disc height as well as a good examination to try and discover what your pain generators could be.

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660
    #32789 In reply to: Arm weakness |

    The C4 nerve (C3-4 level) connects to no important muscles so it could not be causing perceived muscle weakness in the arm. The C5-6 level however can cause weakness of the biceps and wrist extensor which is involved in grip. Your husband has “Bilateral Severe foraminal stenosis” so this still could be causing problems even with the cord injury.

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Pain is not “mental” (typically) but a peripheral nerve signal triggered due to tissue damage. The pain is dependent upon the structure damaged. Your pain could be generated by the C6-7 disc or even from a pseudoarthrosis (lack of fusion) at C7-T1. A set of flexion/extension X-rays or even better, a CT scan would be helpful to differentiate those two. Facet degeneration, commonly unrecognized can also cause this pain.

    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.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Central stenosis at L5-S1 would possibly cause two different sets of symptoms. One is neurogenic claudication; pain and fatigue in the pelvis/buttocks region that would become more intense and start to radiate to the posterior thighs with standing and walking. The longer the stand or walk, the worse the symptoms become until you were forced to sit down or lean over a counter.

    The other symptom could be radiculopathy (nerve root pain) and weakness of the S1 nerves with severe cases leading to calf (foot push-off) weakness.

    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.
    metallikat
    Participant
    Post count: 9

    And now that I think of it, even before surgery, I tried decompression by hanging from a Teeter Dex 2 (back extension exercise equipment) and both legs would totally fall asleep while on it.

    metallikat
    Participant
    Post count: 9

    Hello Dr. Corenman,

    New MRI came back. It says among other things:
    “Disc desiccation and mild loss of disc height ta L5-S1.” [Note the word “mild”]
    “L4-L5: No evidence of […] neuroforaminal stenosis.”
    “L5-S1: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”
    “Impression: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”

    Previous MRI before surgery said:
    “Disc desiccation with loss of disc height.” [Note the absence of the word “mild”]
    “L4-L5: […] Mild bilateral foraminal stenosis”
    “L5-S1: Disc desiccation with loss of disc height. Large right subarticular disc extrusion measuring 11mm AP. Complete effacement of the right lateral recess with impingement on the traversing right S1 nerve root. Mild central spinal stenosis with AP thecal sac diameter of 8mm. No significant foraminal stenosis.”
    “Impression:
    1. At L5-S1, large right subarticular disc extrusion with impingement on the traversing right S1 nerve root.
    2. Facet arthropathy at L4-L5 with mild bilateral foraminal stenosis.”

    Comments/Questions:
    1. I am getting referrals to a neurosurgeon and a neurologist
    2. It is my hope that the surgeon might be able to see on the MRIs if the disc height increased slightly due to traction, etc that was done for some weeks prior to surgery.
    3. The new MRI does not note the mild foraminal stenosis that the old MRI did at L4-L5. Is that something that could have gone away with traction and mobility exercises?
    4. The new MRI did not note the mild central stenosis with AP sac diameter of 8mm. Nor did the old MRI clearly explain what the source of that stenosis was? Any clue? Was the “hose” just narrow for no reason? And could it really have resolved since the last MRI?
    5. The new MRI says protrusion does not cause “significant” stenosis. I take it this is not the same thing as “zero” stenosis. And I read that even without actual contact with the dura, protrusions can cause inflammation in the area, causing nerve symptoms. Given my new bilateral symptoms including weakness, does this protrusion look like the probable cause?
    6. Any chance a surgery would allow me to keep the spinous process, and just get away with maybe having another laminotomy on the other side as well?
    7. Any chance of treating this with traction?
    8. If hernia retracts with traction, would the annulus heal itself over?
    9. Is there time to mess around with such alternatives, or given the weakness symptoms should I just get surgery in your opinion? No one would know I have weakness by looking at my gait.
    10. Since right after the first surgery, extension of both legs would cause nerve symptoms. Does that make sense anatomically given I presumably did not have this protrusion at that time, but only had the extrusion on one side? What explains it? Inflammation/irritation in the general region caused by the surgery?

    Thanks,
    David

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