justenough

Dr. Corenman,

I got a 2nd over read of my cervical MRI that was read by the first RAD as normal / unremarkable and will post the 2nd over read now:

Impression:
1. Reversal of the upper cervical lordosis.
2. C3-4 level: Broad based disc bulge indents the anterior thecal sac eccentric to the right narrowing
the right lateral recess.
3. C4-5 level: Broad based disc herniation indents the anterior thecal sac. Posttraumatic etiology
cannot be excluded.
4. C5-6 level: Broad based disc herniation indents the anterior thecal sac narrowing the central spinal
canal and producing deformity of the anterior cord margin. Posttraumatic etiology cannot be
excluded.

I have not been back to the spine center since the spine center sent me to neurologist after because the 1rst read of cervical MRI was dictated as normal. I was sent for the MRI because the spine center said all extremities had hyper flexia …….and abnormal rhomberg / romberg

plus my own list of symptoms in hands feet ect…

So after seeing neurologist he did EMG on lower extremities and said abnormal….it shows evidence of L5-S1 problem and periphreal neuropathy ( tibial ) bilateral….that neurologist said my disequilibrim is because of nerve loss in feet and tibials …and symptoms in my hands and stuff are neck related……but I am concerned there is pressure on my spinal cord intermittently at times causing more symptoms and damage …I also read this ….

Pathoanatomic investigation of cervical spondylotic myelopathy.
Iwabuchi M, Kikuchi S, Sato K.
Source

Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City 960-1295, Japan. [email protected]
Abstract

Multiple dural sac and spinal cord indentations are often observed on MRI in cervical spondylotic myelopathy. However, it is rare that all of the indented levels contribute to clinical symptoms. Pathological changes in cervical compression myelopathy have previously been reported. Still the critical degree of spinal cord compression needed to induce pathologic changes is unknown. To clearfy this matter the relationships between the spinal cord as well as the dural sac indentations, and pathological changes of the cervical spinal cord were investigated in cadavers. Sixty-eight cadavers were used for this study. The dural sac and the spinal cord were observed especially regarding presence of indentations. The spinal cord was removed from the specimens in order to perform histopathological examination. The indentations of the dural sac and the spinal cord were observed at C4/ 5, C5/6, C6/7 and C3/4 intervertebral levels in order of incidence. However, all of the dural sac indentations were not correlated with spinal cord indentations. Pathological changes in the spinal cord were observed in two specimens with less than 30% of the AP compression ratio. One specimen with 20.9% in the AP compression ratio had remarkable histopathological changes. In the other specimen with 29.6% in the AP compression ratio, diffuse demyelination was distributed in the lateral white matter. The results indicate that the critical degree of the AP compression ratio is 30% to induce histopathological changes in the spinal cord. If a spinal cord indentation in the patient with cervical spondylotic myelopathy on imaging, i.e. MRI, show less than 30% in the AP compression ratio, the clinical symptoms, i.e. numbness, tickling and paresthetic pain, may not be improved after the surgery because of some histopathological changes in the spinal cord.

( this study and result looks sort of contradictory, but all in all it is saying that less then 30 compression on spinal cord has shown pathollogical changes in spinal cord that are irreversable.

I need proper help I feel like I am going in circles and don’t know what to do…

Dr. Corenman,

You make a lot of sense and have such a good understanding……did you happen to see the images I sent to the email notice I get when you respond to my message. I sent it through a reply in that email as an attachment. I know its hard from that image to see the acutal indention in C5-6 but there is no CSF at all in that area and the ligamentum flavum are buckled, that mri was read as normal MRI of cervical spine ?

Dr. Corenman,

It means a lot you took the time to respond and expound as well.

The prior MRI 4 years ago revealed and as the radiologist dictated mild cervical stenosis of 9mm, C5-6 disc herniation abutting spinal cord.

( terminology can make a difference )not sure what abutting means, but the disc was contacting cord at that point, ( my eyes see it resting on cord, no CSF can be seen at that one area, but cord had no indention at that time.

Fast forward………..progressing symptoms………new recent Cervical MRI and that same C5-6 abuttment, has now indented the cord, not drastic, but very evident, in addition as said the PLL ( I believe has 2 levels of bucking, this is lateral and opposite of the DISC side, so hope that is the PLL, there IS still adequate CSF seen in that area, unlike the Disc protrusion that is indenting the cord, but the combination of the 2 decrease the space of CSF as a whole and contribute to the stenosis.

However, the radiologist that read this most recent MRI dictated it as ” unremarkable Cervical MRI ”

The diagnosis the rad saw to read was gait abnormality, and to rule out cord compression.

The reason it was ordered was the Doctors findings of positive Rhomberg, hyperflexia,granted no positive babinski, or hoffmans sign, but my father has obvious cord compression on both sides ( disc and Ligamentum flavum ) maybe I made error in anatomy and terminology, be he has a very ugly MRI with increased signal in his cord yet his hoffman and babinski is normal as well. He also does not have the disequilibrium problem I have and he is 79!

Here is my problem…. standing static as said ..for more then 10 seconds I am rocking and swaying, griping toes and feet to ground to keep upright, it is the most horrific feeling……..taking shower, terrible, scary, I have to hold wall with one hand, but when i have to wash and rinse hair I need both arms, which makes me raise them and then my spine and legs stiffen, I must grip feet and legs so hard to keep upright….anything I do that I have to stand still, raise arms, makes me 70% worse……….walking in dim light or darkness…….forget it!

When I walk ….from point A to B, as long as I am walking and staying in motion it is not as bad, but it seems as if my legs at times during this walking kinda quickly give way, briefly, almost like my hip malfunctioned …also I do not walk with wide gait, but I think because of my hips and sacro I take shorter smaller steps ( side note, for some reason I have neuropathy in both feet, ( I also have bilat carpal tunnel tested through EMG ) my feet have not been tested and the issue seems be more on outside of ankles, not inside and just touching the skin sends millions of little shocks that spread like fingers down the top of foot to toes…also absent ankle reflexes….but I have not had an EMG of ankles and feet, but I know its neuropathy, my wrists have same thing happen even if I lightly scrath both insides of wrists…

I wish I could have you look at the actual films…….would you have read the cervical MRI as ” unremarkable ” That is the wording, that is it.