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in reply to: back pain since 2months #4827
Thank you for your information. You describe your MRI well but do not describe your symptoms with enough detail. “Severe back problems” and pain in both legs needs to be further explored. First, do you have any motor weakness in your legs or bowel/bladder changes? Is the pain worse in your lower back or in your legs? What is the ratio? Is it 50/50, 60/40, 70/30 or the reverse (legs more painful than lower back) 30/70 etc. What makes the pain worse? Is the pain worse with walking and standing or increased with sitting, bending or????
The herniation in your lower back according to the report is significant. “Severe lumbar canal stenosis” generally means a very large herniation causing significant compression. Generally, these very large herniations can be associated with motor weakness or cauda equina syndrome (see website). If either of these are present, in my opinion, decompression surgery needs to be performed.
If the pain is significant and you cannot ambulate, again, surgery would be recommended to gain the fastest recovery.
The T11-L1 degeneration/deformity is probably old Scheuermann’s disease and has been present for quite a while. Most likely, this is not causing the current symptoms.
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.in reply to: Disc Prolapse C4/C5 #4826You have more neck than shoulder pain. The pain increases with neutral head position and further increases with extension (bending the head backwards). You do not mention shoulder (deltoid) weakness so I will assume there is no upper extremity weakness. You also do not mention imbalance, problems with your hands involving fine motor skills, lightening type sensations down the spine and extremities and bowel/bladder symptoms so I will assume there is no spinal cord compression.
The steroid injection is not a pain killer. The steroid reduces inflammation and strengthens the nerve membrane so it is therapeutic. This injection can change the nerve environment and can give long lasting relief. The steroid injection will do nothing for motor weakness however.
Rest by itself for 6-8 weeks would not be recommend as your neck muscles can become deconditioned. You do need to avoid the positions of your neck that cause pain so wearing a soft collar may help you. Physical therapy can be helpful and is recommended.
The swallowing difficulty should be worked up by a specialist such as an ear-nose-throat doctor (ENT).
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.in reply to: Disc Prolapse C4/C5 #4822Your 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.in reply to: Pain in Lumbar region #4817Let us start from the beginning. You need to explain much about your symptoms. When did the symptoms start, where exactly are they, which body parts hurt the most, when does the pain become the worst, what activities increase and decrease the pain, what is the highest pain level, how are you limited, what is your occupation, etc..? You then need to discuss what you have done to obtain a diagnosis, what therapies you have had, what has temporarily helped and so forth.
What imaging studies have you had? What other tests have you undergone?
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.in reply to: Numbness/hurting/ tingling in limbs #4814The examples I gave you are but a small fraction of the neurological processes that can cause your symptoms. The target lesion you developed after a tick bite could be the beginning of Lyme disease and the test might have been performed before you developed antibodies. Don’t just focus on Lyme disease however.
Again- a top notch neurologist is the best direction in my opinion.
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.in reply to: Numbness/hurting/ tingling in limbs #4812Your symptoms of progressive paresthesias and pain in all four extremities for 2-3 years associate by headaches, dizziness and flushing could be from many different diagnoses. These symptoms could be all related from one disease process or originate from separate diagnoses.
Multiple Sclerosis is not an unreasonable diagnosis to consider. You don’t mention your skin tone (MS is more common in younger individuals originating from Northern Europe). Negative MRIs of your neck and brain do not fully rule MS out but with your extent of symptoms, it makes MS very unlikely. A spinal tap would be positive in 60-75% of individuals with MS. Since MS is a disease of the central nervous system, MS would not be found in the lumbar spine and even if it could originate there, would not affect your upper extremities. The physical examination should demonstrate long tract signs (hyper-reflexia, Hoffman’s, clonus, Babinski) in the face of MS.
Myelopathy would also be unlikely based upon symptoms. If your MRI of the cervical spine was negative, cord generated myelopathy would be ruled out and the MRI would also rule out Arnold Chiari syndrome.
You may have an inflammatory, metabolic or infectious origin of your symptoms. Polymyalgia Rheumatica, Vitamin B12 deficiency or Lyme disease come to mind.
You need a top notch neurologist to help you with your diagnosis.
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. -
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