Jellyhall

Dr Corenman,
At last I have received the letter from my neurologist.
His clinical impression is that all my symptoms, except for some temporal and mandibular joint pain, are compatible with a cervical cord lesion. I assume from this he means cord compression.

He viewed my cervical MRI scan with a Consultant Neuroradiologist.
At C3/4 and C4/5 there is an element of cord flattening but without evidence of myelopathy. (I assume here they mean high signal on the cord.) There is multiple radicular evolvement extending from C4 bilaterally down to C7, most severe bilaterally at C4.

(He doesn’t mention viewing my brain scan, but my GP says we must assume that he did and didn’t find anything abnormal.)

An EMG report showed mild to moderate chronic neurogenic changes in the deltoid and bicep muscles with relatively more prominent changes in the left deltoid. These were consistent with cervical radiculopathy. Triceps muscles showed relatively minor abnormalities. Median and ulnar conduction studies were within normal limits bilaterally.

He agrees with a neurosurgeon registrar’s letter that states that I have significant C3/4 and C4/5 cervical degenerative spinal disease with significant canal stenosis, and that I would eventually require surgery. This canal stenosis was evident on a scan done in October 2010.

Dr Corenman, I have read of other people sending their MRI scans to you for your opinion, and I was wondering if this was possible for me?

Yes the brain MRI scan was to check for MS. I don’t have the results of that yet. I have had several MRI scans of my spine at all levels, including my thoracic that showed 2 herniated discs, one slightly indenting the cord. I have already had a fusion of my L4/5 for isthmic spondylolisthesis. No-one mentioned any lesions on these scans, only osteophytes, hypertrophic facets and disc problems. My neck from C3 to C7 is very degenerated with disc herniations and osteodiscal ridges, but it is C3/4 and C4/5 that are concerning them, as there is significant cord compression.
I do have hyperreflexia in my arms and legs but no Hoffman’s. I have unequivocal Babinski as there is no movement of my toes apart from a very slight flaring of my 2nd to 5th toes. I don’t have Lhermitte’s sign although I do get occasional shooting electric shocks out of the blue. I had no Rhomberg’s sign although I do sometimes feel off balance, especially if I turn. I do get frequent pins and needles, stabbing and burning in my arms and legs especially my hands and wrists and my feet and ankles. I don’t appear to have Clonus. I get twitching, fluttering and cramping, particularly in my legs and feet, but also have twitching in my right arm. I get a feeling of a mobile phone on vibrate in my right leg which is also starting to appear in my left arm, and a frequent feeling of having cold water splashed on my arms, legs and abdomen.
The symptoms that bother me the most are the frequent headaches and these stiffening spasms in both legs and sometimes around my abdomen as I wake in the morning or when getting up after sitting for a long time. My right foot turns inwards strongly with my big toe sticking up when I have these spasms. Then the first steps of walking are very stiff, but I loosen up as I get moving.

I am very interested to hear what you think of all this.

How common is it to develop adjacent disc problems after a cervical fusion? This is something that I am concerned about, particularly as I have a lot of degeneration throughout my neck.

If it did happen, how long might it take to cause serious problems?

Is the risk the same for a lumbar fusion?

Thank you for your patience with all my questions. As I try to get my head around needing to have surgery, I just keep thinking of questions.