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Neurology (Expert Forum)
Cervical Spondylosis at C4/5. C5/6 and C6/7 with myelopathy at C2/3
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Cervical Spondylosis at C4/5. C5/6 and C6/7 with myelopathy at C2/3
by tommy, Nov 17, 2000 12:00AM
I am male aged 48. I have progressive numbness of hands and legs over the past three weeks. I can’t tell the temperature of water on my left hand side from my foot to my chest. The MRI scan shows three level disc prolapses with cord indentation at C4/5, C5/6 and C6/7. At C2/3 and C3/4, hyperintense signal and enhancement are noted in the spinal cord. However, there is no focal compression of the spinal cord at these levels.
I have seen three neurologists and one neurosurgeon. Their opinions are split. Two doctors recommended a three level disc surgery as soon as possible. They believe the myelopathic changes in C2/3 and C3/4 are due to venous congestion and ischemic change form venous congestion from the site below. However, the other two doctors advised that I should not go into any operation without understanding the cause of the myelopathic change at C2/3 and C3/4, and it might cause more harm than good.
All four doctors said that they have not handled any cases where the myelopathic change appears above the three level disc prolapses and they are puzzled. My questions is are there any tests that can determine whether the myelopathic change at C2/3 and C3/4 are linked to the disc prolapses at the lower sections? If these are separate problems, I can then determine the priority of treatment to each.
Thank you.
Tommy
I have seen three neurologists and one neurosurgeon. Their opinions are split. Two doctors recommended a three level disc surgery as soon as possible. They believe the myelopathic changes in C2/3 and C3/4 are due to venous congestion and ischemic change form venous congestion from the site below. However, the other two doctors advised that I should not go into any operation without understanding the cause of the myelopathic change at C2/3 and C3/4, and it might cause more harm than good.
All four doctors said that they have not handled any cases where the myelopathic change appears above the three level disc prolapses and they are puzzled. My questions is are there any tests that can determine whether the myelopathic change at C2/3 and C3/4 are linked to the disc prolapses at the lower sections? If these are separate problems, I can then determine the priority of treatment to each.
Thank you.
Tommy
Doctor's Answer
by CCF Neuro[P] MD, RPS, Nov 17, 2000 12:00AM
Dear Tommy:
Sorry that your having problems with your spinal cord. I would agree with the group that is telling you that an etiology is needed. As previously stated, the changes in the spinal cord is above the lesions in the discs, and this is not usual. It might be helpful to get SSEPs on your tibal and median nerves. One might get a better idea of what is going on below the lesion, and some information on the upper cord as well. Make sure that you go to someone who routinely does SSEPs and knows how to read them. If there are lesions detected below the discs in question then you might have something else going on besides just the discs. If there are not changes below the discs then the discs are not the problem.
Sincerely,
CCF Neuro MD
Sorry that your having problems with your spinal cord. I would agree with the group that is telling you that an etiology is needed. As previously stated, the changes in the spinal cord is above the lesions in the discs, and this is not usual. It might be helpful to get SSEPs on your tibal and median nerves. One might get a better idea of what is going on below the lesion, and some information on the upper cord as well. Make sure that you go to someone who routinely does SSEPs and knows how to read them. If there are lesions detected below the discs in question then you might have something else going on besides just the discs. If there are not changes below the discs then the discs are not the problem.
Sincerely,
CCF Neuro MD
