Jellyhall

Thank you Dr Corenman,

I suppose that he could have ordered the EMG and nerve testing to see if there is nerve root compression.

My MRI report from April 2013 does mention at C4/5 a small residual osteo discal bar indenting the anterior sub arachnoid space without any residual cord compression. Moderate right C5 foraminal narrowing.

At C5/6 an osteo discal bar indents the anterior sub arachnoid space without cord compression. Moderately severe right C6 foraminal stenosis, mild left C6 foraminal narrowing.

At C6/7 the spinal canal dimensions are adequate, moderate bilateral foraminal stenosis.

At C7/T1 capacious spinal canal and foraminal dimensions.

Of my lumbar spine it says :
In the lumbar spine post-operative changes are again noted with L4/5 pedicle screws and laminectomies. There is persistent Grade 1 spondylolisthesis at this level but the spinal canal dimensions remain capacious. There is persistent moderate left L4 foraminal narrowing although the nerve root does not appear frankly compressed. Small disc bulge at L3/4 produces mild spinal canal narrowing unchanged from before with associated moderately hypertrophic degenerate facet joints but there is no significant canal or foraminal stenosis at this level. All other levels relatively normal appearances with no acute lesion.

I will see the neurologist again in August when hopefully I will have had the MRI and EMG and nerve testing and will have some answers.

Thank you for giving me your valued opinion. It is so helpful to be able to ask questions without having to wait for such a long time.

Thank you Dr Corenman.
Some more questions;

Is it possible to have cord injury without high signal on the MRI scan?

The first neurosurgeon that I saw left me for over two years with cord compression while he ‘waited and watched’. (I am in the UK!) I was seen at 6 monthly intervals, and each time by his registrars and they felt that the symptoms I had indicated that I had myelopathy and should get on with an ACDF, but when they went to talk to him, they would come back and say that he said we should continue to wait and watch. This was without him coming into the room and examining me himself or explaining why he felt that we should continue to wait. I got another opinion and that neurosurgeon said that we should get on and do the surgery because ‘things were very tight on my cord’ which was being pushed back and indented. (You were kind enough to also view my MRI scans and you felt that my neck needed attention.)

How is a permanent cord injury managed?

I still have most of my pre-surgery symptoms and get stiffening spasms several times every day when both legs either go stiffly straight or bend upwards with tight muscles. When this happens my feet, but especially my right foot, turn inwards with my big toe pulling tightly upwards. Also I get tight muscles around my abdomen which causes my back to arch up off the bed. I also get a mobile phone type buzzing in my legs (mostly right leg) and the feeling of cold water being splashed on me. I also have pain and symptoms in both hands and arms (mostly on the right). I think that this is coming from the levels below the fused levels, which were C3/4 and C4/5. I also have tingling and nerve pain in my feet, legs and buttocks.

I am seeing a neurologist soon to discuss my symptoms with him. I have not had a nerve tesst done since the surgery, but I assume that he will do one to check my reflexes etc.

I may have got the wrong idea about removing bone. At the moment there isn’t a plan to do surgery, just to have a full spine MRI scan with contrast to see what is going on to cause my numerous remaining symptoms. He said they could be coming from compression to the cord (or remaining symptoms from that) or to the nerve roots. I assumed that this would include bone and ligament, but perhaps I was wrong.

I remembered that before my surgery he had said that he may need to do another surgery from the back afterwards and so I asked what he had meant by that, and which levels he had been thinking of. He told me that things had been very tight in there, both on the MRI and when he saw inside. He didn’t name the procedure that he would do. I do know that I have a congenitally narrow canal. I think that before surgery he felt he may still need to get more pressure off the cord and nerve roots from the back afterwards. He referred to the EMG testing that showed ‘chronic neurogenic changes’ to the muscles in both arms. These are the deltoid, biceps and triceps muscles which I believe are fed from nerves below my ACDF at C3/4/5. I asked him if he would do a fusion and he said that he didn’t think it would be needed because the C3/4/5 levels were now fused and the two levels below that look like they are self fused. I do have lots of degeneration and osteophytes at all levels.

Before my surgery he had said that he would only fuse the two worst levels because if he did more than that there was a higher chance of not having a successful surgery.

He did explain that the nerve (laryngeal, I assume) may have been injured or stretched during the surgery (his incision is on the right side) which could be why I have lost my singing voice.

Once we have the new MRI scans I am sure that we will talk again and I will make sure that I understand what he intends to do, and make sure that I get a procedure name. He is generally good at writing down what he intends to do.

Thank you Dr Corenman for your help