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#35422 In reply to: Epidural Fibrosis |
Bone spurs are typically caused by the insertion of a ligament abnormally pulling on the bony insertion. This tension causes damage to the insertion at the bony interface and causes the bone to “heal” the injury by putting more bone down, the formation of the spur.
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.#35406Topic: Right Arm Movement Disorder in forum NECK PAIN |Over the last 10 months I have experienced a slow and increasing loss of fine motor skills, coordination and proper movement in my right arm (I cannot brush my teeth, write, chop veggies or whisk with the affected arm, though I can still perform gross movements and haven’t experienced any loss of strength). I am also having arm/hand muscle spasms that cause my arm and hand to be “tense” while at rest (clawing and bending at the elbow). I have no pain, tingling or numbness (unless I fall asleep on that arm). I have seen a neurologist and three orthopedic doctors (upper extremity and spine doctors) and have had x-rays, brain MRI, spine MRI, nerve conduction studies and EMG – all with negative results, everything unremarkable, everything functioning properly. I have also tried medical massage and physical therapy. I feel that this is a neurological problem arising from the cervical spine, even though the neurologist I saw said everything checks out. I was wondering if you had any thoughts as to next steps… rheumatologist? Neurologist second opinion? Chiropractor? Thanks for your time!
#35384Topic: MRI Results vs. Symptoms in forum READING X-RAY, MRI & CT SCAN |Hello Dr. Corenman,
I am so thankful to have found your website! It looks like a wealth of resources that I look forward to digging into soon. Looking for any insight into some symptoms and my MRI results. I’ll try to be as concise as possible.
Traumatic Cervical Injury-6 years old (1990?)
Cervical disc herniation w/corticosteroid injection in college followed by chiropractic care for years for pain management (2005?)
In addition to chronic cervical pain & fatigue, the last year or so I have developed some slowly progressive symptoms, such as bilateral muscle weakness in my arms and legs, pulling sensations in my hands and feet (sometimes very painful), eye strain/blurry vision (ophthalmology work up negative), fullness in my ears, migraines, & dizziness. All symptoms are intermittent in severity & presence except the neck pain/pressure and ear fullness are constant.
A month ago I developed severe shortness of breath at rest (no hypoxia) and slight tachycardia (120-130 bpm). Lasted 4 days. ER visit negative for any known cause. Outpatient cardiac testing negative. Still have underlying shortness of breath with exertion but not to the extreme of those 4 days. CT head only showed a right 6mm cerebellar tonsillar ectopia. Awaiting neurology follow up in the mean time. MRI Cervical/Thoracic Spine results:
MRI CERVICAL SPINE W WO CONTRAST, MRI THORACIC SPINE W WO CONTRAST
CLINICAL INFORMATION: 38 years-old Female, Motor neuron disease.
COMPARISONS: None.
TECHNIQUE:
Multiplanar, multisequence, MR imaging of the cervical and thoracic spine
without and with contrast was acquired.CONTRAST: 7 mL Gadavist
FINDINGS:
Cervical spine:
Craniocervical alignment preserved. Straightening of the usual mid cervical
lordosis. No abnormal spondylolisthesis. Vertebral body heights are
preserved. Minimal marrow edema along the C7 superior endplate is likely
degenerative in nature. A small area of marrow STIR hyperintensity at the
left pedicle/facet junction also has intrinsic T1 hyperintensity, most
likely a benign hemangioma. No significant paraspinal soft tissue
abnormality. No abnormal epidural fluid collection. The cervical spinal
cord is normal in caliber and signal intensity. Degenerative changes are
detailed by level below.Segmental analysis:
C2-C3: Unremarkable.C3-C4: Unremarkable.
C4-C5: Mild left uncovertebral hypertrophy and small leftward disc
osteophyte complex blending with uncovertebral hypertrophy resulting in
mild left foraminal narrowing.C5-C6: Minimal uncovertebral hypertrophy, minimal disc height loss, and
small disc osteophyte complex result in ventral cord contour flattening but
no significant spinal canal narrowing.C6-C7: Minimal ligamentum flavum infolding and small disc osteophyte
complex with mild spinal canal narrowing.C7-T1: Unremarkable.
Other findings: There is 6 mm right cerebellar tonsillar ectopia without
significant left cerebellar tonsillar ectopia, pointed configuration of the
right cerebellar tonsil, or substantial foramen magnum crowding. This is
most likely incidental.Thoracic spine:
Mildly exaggerated upper thoracic kyphosis. Minimal anterolisthesis of T2
on T3 Mild thoracic dextroconvex curvature with apex at T7-T8. Vertebral
body heights are preserved. Small foci of marrow STIR hyperintensity within
the T7 and T8 vertebral bodies have signal dropout on out of phase gradient
in phase imaging, likely small hemangiomas with atypical signal features.
Paraspinal soft tissues are without significant abnormality. No abnormal
epidural fluid collection. The thoracic spinal cord is normal in caliber
and signal intensity, accounting for mild intermittent artifact.There is mild thoracic facet arthropathy primarily at the upper levels on
the right. There is mild leftward disc height loss at T6-T7 and T7-T8
primarily due to curvature effects. There are small anterior projecting
endplate osteophytes at upper and mid thoracic levels but there are no
significant disc bulges, protrusions, or extrusions. The spinal canal is
patent without significant stenosis. Foraminal narrowing is minimal on the
right at T2-T3.Degenerative changes of the low lumbar spine are incompletely evaluated on
all spine images obtained for localization purposes.IMPRESSION:
1. No cervical or thoracic spinal cord lesions.
2. Degenerative changes of the cervical spine as detailed by level in the
body of this report. Spinal canal narrowing is mild at C6-C7 and foraminal
narrowing is mild on the left at C4-C5.
3. Mild thoracic spine facet arthropathy and mild anterior endplate
osteophytes without disc bulge, protrusion, or extrusion. Foraminal
narrowing is minimal on the right at T2-T3 and there is no significant
spinal canal narrowing.
4. Mild right cerebellar tonsillar ectopia, likely incidental.Thank you so much for your professional opinion!!
Lydia
#35332 In reply to: Chronic neck pain |Hello —
Update: I had facet joint injections on 8/12 and had some short term relief. Instead of moving forward with the next steps, I decided to try the epidural cortisone injection on 9/23. The doctor said I may feel pain across the chest and down the arms as he does the injection, which I did feel. After a few days, I started having bad pain in my neck (shock-like and intense aching) and sharp pains in my arms, hands and fingers as well as parentheses.
I had an upcoming appointment with my neurologist that performed a nerve conduction test on my legs and an EMG since my neurosurgeon only did my arms and hands. The test revealed a possible pinched nerve in my left leg. He also ordered another MRI and MRA of my C-spine and an MRI of my L-spine and wrote me a referral to see a neuromuscular doctor to evaluate me for small fiber neuropathy or other neuromuscular diseases. My feet have hurt me for 30 years (since I had CFS). The difference is the numbness and shooting pains.
I am not able to get a follow-up appointment with him until mid December. I made an appointment with a neuromuscular doctor which is in Dec. as well. I have a follow-up with the neurosurgeon coming up.After talking to my pain management doctor, he suggested I ask the neurosurgeon about trying a spinal cord stimulator.
The results from the current MRI of my C-spine and L-spine is below. I haven’t had the MRA yet.
HISTORY: 55 years Female 55 year old female. Neck pain with bilateral upper extremity radiculopathy for a year. No recent trauma. History of cervical spine surgery October 2021.
TECHNIQUE: Using a 3.0 Tesla magnet, multiplanar T1 and T2 weighted images were acquired.
COMPARISON: MRI 3/12/2022, CT 7/11/2022
FINDINGS: Stable anterior fusion with plate and screws at C5-6. There is no evidence of acute compression fracture or subluxation.
Bone marrow signal shows no evidence of bone marrow edema.
Disc spaces are maintained.Spinal Cord: Normal caliber, contour and signal intensity.
C1-2: Preserved with no atlantoaxial subluxation or significant separation.
C2-3: No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.C3-4: No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C4-5: No disc bulge. Stable small central herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C5-6: Stable moderate bony ridging. Stable mild degenerative buckling of ligamentum flavum. No disc bulge. No herniation. No facet and/or uncovertebral arthropathy. Stable moderate central canal stenosis. Stable moderate bilateral foraminal stenosis.
C6-7: Stable mild disc bulge. No herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.
C7-T1: No disc bulge. New small herniation. No facet and/or uncovertebral arthropathy. No central canal stenosis. No foraminal stenosis.Paravertebral/Prevertebral soft tissues: Unremarkable.
IMPRESSION: Stable anterior C5-6 fusion. Stable C5-6 annular bulging, degenerative buckling of ligamentum flavum, moderate central and bilateral foraminal stenosis. Stable small C4-5 central disc herniation, mild C6-7 annular bulging, and new small C7-T1 disc herniation.HISTORY: 55 year old female with left side lower back pain. Pain radiates down the left leg and into bot feet. Symptoms began years ago. No trauma. No prior lumbar spine surgery.
TECHNIQUE: Sagittal T1, T2 and inversion recovery, coronal T2, and axial T1 and T2 images are obtained through the lumbar spine without intravenous contrast in a 3.0 Tesla scanner.
COMPARISON: MR lumbar spine 7/23/2020.
FINDINGS: Conus medullaris ends at L1 and appears unremarkable.The kidneys show no evidence of hydronephrosis. Included portion gallbladder shows no evidence of calculi .normal size common bile duct. Small umbilical hernia containing only fat.
At L1-2, annular bulge. Neural foramina and thecal canal are adequate.
At L2-3, neural foramina and thecal canal are adequate.
At L3-4, left lateral disc herniation narrowing left L3 foramen without foraminal nerve root compression image 6 series 3. Tarlov cyst at L3 foramen on the right side image 11 series 4. Mild bilateral facet degeneration. Thecal canal is adequate.
At L4-5, annular bulge. Neural foramina and thecal canal are adequate. Small Tarlov cyst on the left side.
At L5-S1, neural foramina and thecal canal are adequate.Visualized portion of the sacroiliac joints appear unremarkable. Tarlov cyst at L5 on the right side measuring 8.2 mm at S1 on the left side measuring 15 x 13.5 mm and S2 on the left side measuring 8.5 mm and on the right side measuring 9.3 mm. Tarlov cyst scalloping the posterior margin of the S1 and S2 vertebral bodies.No pedicle edema or spondylolysis detected.
IMPRESSION: Left paracentral and lateral disc herniation at L3-4 level narrowing the left L3 foramen. Tarlov cysts in the right L3 foramen. Additional Tarlov cysts in the right L5 and left and right S1 and S2 foramina. These are usually asymptomatic. Occasionally they can be a source of nerve root compression. Findings unchanged since previous examination 7/23/2020.#35324 In reply to: I’m accepting this surgery at neurosurgery |I had an add on extension to the S1-T10 taking it up to T4 18 months ago. No I have not had diagnostic testing for pain such as ablation but I did have short term success with trigger point injections at T4 but would wear off quickly. The loose screws at C7 were a bonus find on tspine imaging. Surgeon said if it’s not causing me trouble swallowing we will watch and wait. This is the first time I heard non union at that C level. I believe the compression fracture which wedged within 6 weeks of the extension will never heal on its own without surgery. Then the kyphosis issue.
#35320Topic: I’m accepting this surgery at neurosurgery in forum BACK PAIN |Hello Doctor. This is the plan I agreed to as 18 months of constant pain is ruining my quality of life. I sure hope it ends the pain at T4 both back and front of my chest. Do you see alot of cases like mine?
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CHIEF COMPLAINT:
Mid back and neck pain.HISTORY OF PRESENT ILLNESS:
Patient is a 68-year-old female who has undergone multiple surgeries in
the past. She underwent ACDF as well as a thoracolumbar fusion at an
outside institution. She was found to have some adjacent level disease
and kyphosis and underwent extension into her midthoracic spine with me
approximately a year and a half ago. She did well but suffered a
compression fracture at her upper instrumented vertebrae with some
midthoracic back pain. She has also a backed out screw at C7 with
pseudoarthrosis at C6-7. She has failed conservative management with
physical therapy and trigger point injections. She is not interested in
ablation at this time.REVIEW OF SYSTEMS:
See HPI and prior notes, otherwise negative.PHYSICAL EXAM:
Unable to perform.RESULTS REVIEWED:
Patient’s CT was again reviewed that shows loosening of her T4 screws,
as well as the backed out C7 ACDF screw.ASSESSMENT AND PLAN:
Patient is a 68-year-old female with a T4 fracture with loosening of her
screws as well as a pseudoarthrosis at C6-7. We again discussed
surgical and nonsurgical options. Not sure if surgery will fix all of
her pain issues but I think she would be a candidate for an extension of
her fusion to her mid cervical spine. This would likely be a C5-T4
instrumentation and fusion. We discussed risks, benefits, and
alternatives of surgery. She will need anesthesia clearance prior to
surgery.This was a telephone encounter. I spent over 15 minutes with the patient, more that half was spent counseling and coordinating care.
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