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in reply to: Facet Joints #28537
Happy Father’s Day Dr Corenman!
I have some additional questions please, after having my standard MRI’s, flexion/extension X-rays, CT scan and EMG/Nerve conduction. My results were:
Thoracic Spine
T1/T2 disc space level, postsurgical changes are noted. Posterior stabilization rod is noted with paired transpedicular fixation screws transversing the T1 and T2 vertebral bodies. No evidence of herniated disc or sideline thecal sac deformity . Loss of disc signal is noted with preservation of disc space height.
T2/3, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T3/4, disc herniation is noted deforming the thecal sac with bilateral paracentral components, Loss of disc signal is noted with partial loss of disc space height.
T4/5, left paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T5/6, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T6/7, disc bulge is noted with paracentral orientation deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
T7/8, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T8/9, disc herniation is noted deforming the thecal sac with bilateral paracentral components.Loss of disc space height and signal is noted compatible with mild disc degeneration.
T9/10, right paracentral disc herniation is noted deforming the thecal sac. Loss of disc space height and signal is noted with mild disc degeneration.
T11/12, disc bulge is noted deforming the thecal sac. Loss of disc space height and signal is noted compatible with mild disc degeneration.
These extruded disc exert extradural pressure. Ventral dural tube subarachnoid space is impacted upon and deformed. Spinal cord surface is also encroached, without resulting in flattening.
Central canal integrity is partially compromised. Persistent thoracic multilevel discopathy noted
Cervical spine
C2/3 disc space level, disc herniation is noted deforming the thecal sac abutting the spinal cord contributing to mild central spinal stenosis in conjunction with posterior ligamentous hypertrophy. Loss of disc signal is noted with preservation of disc space height.
C3/4-C6/7 postsurgical changes are noted with anterior fusion plate and anterior fixation screws transversing the C3-C7 vertebral bodies. Graft placement associated with discectomy and fusion procedures are noted at C3/4, C4/C5, C5/C6 and C6/C7 disc space level. Hypertrophic changes are noted at each level deforming the anterior margin of the thecal sac. C3/C4 mild left neural foraminal narrowing is noted in conjunction with facet and ucinate hypertrophic changes.
At C7/T1 disc buldge is noted deforming the thecal sac.Loss of disc signal is noted with loss of disc space height anteriorly associated with mild disc degeneration.
Cervical spine straightening is noted
Ct Scan – Per doctor noted straightening and solid fusion
Flexion/extension Xray – no instability
EMG/Nerve Conduction states abnormal study:
1.Mild left carpal tunnel syndrome
2.Chronic lower cervical radiculopathy bilaterally at C5, C6, C7, and C8 nerve roots
3. Acute findings affecting the cervical paraspinals/dorsal roots.
My surgeon would like to perform a two step procedure, first remove posterior instrumentation since he feels this is likely causing nerve irritation, and second have a plastic surgeon work on trapezius muscles his opinion is there is displacement of the muscles.
I’m really hesitant on having a seventh spine surgery and was told this surgery may improve my symptoms. As you know, i’m still having great amount of pain at the base of the neck, shoulder’s pain, occipital headaches on right side with dizziness, both biceps pain, fingers tingling, etc.
My pain doctor told me he can’t inject C5, C6 and C7 because there is no joints and he does not perform SNRB in the neck area.
Can you give me any recomendations? Thanks
in reply to: Facet Joints #27916Good afternoon Dr Corenman,
I hope all is well on your end. My question is in regards to my continued pain in the base of the neck. Today my pain doctor performed a bilateral block in C3/C4 and I noticed some improvement in that area however no relief in the base of the neck. Because I had a previous bilateral C5, C6 and C7 facetectomy he could not inject those levels.
The question that is now being raised is a couple of weeks ago, I was looking under my bed to retrieve our 8 months old puppy and when i looked up i heard a very loud pop and clunk noise, immediately thereafter the most severe debilitating burning pain can be felt at the base of the neck which transitioned to what i would describe as a charley horse of both muscle’s at the base of the neck. When I mentioned this my pain management doctor, he said that my surgeon should order some scans to take a look, could be something going on with C7/T1? I asked if that would be an Xray (flexion/extension) and was told that an MRI (flexion/extension) may be better, however that’s up to my surgeon.
My question is what would be the difference between flexion extension X-rays verse flexion extension MRI’s?is one better than another, etc? In addition I was told that “The screw in C7 does not look significantly out of place” per my review of my last X-rays. Any help would be appreciated. Thanks
in reply to: Facet Joints #27676Dr Corenman,
The injections at T1, T2 and T3 did nothing for the pain and muscle spasms at the base of neck. I was told the screw in C7 (Peek cage) is out of place but not significantly. Should this be a concern if I’m fused? The doctor said he does not perform fusions, and not the best person to ask about the best next step. Thanks
in reply to: Facet Joints #27500Good morning Dr Corenman,
I received six injection’s yesterday at T1, T2, T3. The injections were performed in the facet joints. My doctor told me they don’t perform SNRB because of the close proximity to a major artery. I didn’t feel any relief in the base of the neck.
We spoke briefly and he referred me back to my surgeon. He explained EMG and MRI confirms foraminal stenosis on C5 nerve(C4-C5 foraminal canal), C6 (C5-C6 foraminal canal). He asked me to refer my questions to my surgeon on how is it possible to have continued foraminal stenosis after posterior bilateral cervical laminectomy, foraminotomies, medial facetectomies, at C5-C6, C6-C7, C7-T1 and posterior segmental instrumentation at C5, C6, C7, T1 and T2. From the sound of it a posterior foraminotomy procedure maybe required. Would it be possible for you to look at my scan’s and give me some direction on what I should do next? All this back and forth is tiring. Thank you
in reply to: Facet Joints #27482Thank you so much!
in reply to: Facet Joints #27479Hello Dr Corenman,
I have an appointment on Thursday and will ask her the question again. In reviewing my MRI report it states “desiccated annular bulges arise at C2-C3 and C7-T1”. “These discs mildly efface epidural compartment and thecal sac”. How can C7-T1 have an annular bulge if I have a peek cage? (confusing to me).
My goal is have SNRB at C4, C5 and C6 and see if I get good pain relief. The C7/T1 is also an area that I’m placing a lot of focus on because I’ve been told by at least three doctors that the base of neck pain, ring and pinky finger’s pain, etc is indicative of C7/T1 issue.
Should I also ask for a SNRB at C7/T1? Thanks
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