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Diagnosis: Bulging Disk/Stenosis. Now What?
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Diagnosis: Bulging Disk/Stenosis. Now What?

I'm a 42 year-old active and otherwise healthy male.

I recieved whiplash 10 years ago in a rearend car accident.  Besides excruciating pain in my neck at the time of the crash, I suffered only a strange, but permanent, sensitivity to the skin on the back of my skull and neck - resulting in a sunburn-like sensation when touched.  I also had moderate numbness in my upper back just below my neck.

5 years later, I suffered a strange injury that resulted in severe right shoulder pain, then atrophy & weakness in my right pectoral, triceps, forearm and latissimis. At the time, nerve conductivity tests noted considerable nerve injury. I was given anti-inflamatories and told to give it time to heal.  The Neurologist said I'd probably just stretched the nerves.

I let it go for 5 years with no improvement - the atrophy and weakness are still present.  I've managed to still be very active although my dominant right side is very weak with pronounced mucle wasting.  I've learned to compensate by using other muscles, I suppose.

A couple times a month, I experience headaches in conjunction with pain in my right/rear neck muscles.   I also experience a sensation much like "Restless Leg Syndrome" in which my legs get really antsy while laying down, just before I fall asleep.

A few months ago, I started experiencing inexplicable severe pain in my right shoulder / shoulder blade area.

I went to a Chiropractor.  X-rays indicated two seperate disk compressions (C5 & C6). Started traction therapy which resulted in severe pain, pins-and-needles and numbness in my right shoulder, scapula, arm, hand and fingers during the actual traction.  These symptoms would stop shortly after each treatment ended.  This was the type of traction that  was supposed to re=establish the curve in my neck.

I stopped traction after 2 or 3 treatments, but the numbness and pins-and-needles are now constant with spikes in severity several times an hour.  My right thumb, index and middle fingers and the top of my hand are continiously numb.

Had an MRI two weeks ago indicating a bulging disk (C6/C7) with "moderate to severe Stenosis".  Waiting for my doctor to give me a referral to a Neurosurgeon. I'm dealing with an HMO and everything seems to be moving very slowly.  My doctor had a sense of urgency (over the phone) once he finally got back to me with the results.  After I see the referral Neurosurgeon, I plan on getting a second opinion from a Neurosurgeon of my choosing.

Is surgery in my immediate future?  If so, am I a candidate for Endoscopic surgery?  What about my prognosis - is the 5-year old muscle atrophy and weakness permanent?

After treatment, will my neck be forever more susceptable or prone to injury due to my active lifestyle? (I race motorcycles).  

Thanks.
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I got my written report this morning. I can't really make heads or tails of it at this point.  Here it is below.  Anyone care to translate it for me.

There is mild reversal of the normal cervical lordosis of the cervical spine with the apex centered at the C5-6 level. The vertabral body heights are within normal limits. There is moderate disc space narrowing at the C5-6 and C6-7 levels, and there are Modic type II changes seen at the C5-6 level. The posterior fossa is unremarkable. The spinal cord is of normal signal and caliber.

At the C2-3 level: There is no significant disc bulge, central spinal canal stenosis or neuroforaminal narrowing.

At the C3-4 level: There is no significant disc bulge. There is mild uncovertebral joint and facet hypertrophy which causes mild to moderate neuroforaminal narrowing bilaterally with the left being slightly greater than the right. There is no significant central spinal canal stenosis.

At the C4-5 level: There is 1-2mm disc bulge at the C4-5 level with no significant central spinal canal stenosis. There is mild uncovertebral joint and facet hypertrophy, more prominent on the left than the right with causes mild neuroforaminal narrowing on the left. The right neurolforamen is patent.

At the C5-6 level: There is a 2-3mm diffuse disc bulge and uncovertebral joint and facet hypertrohpy, more prominent on the right than the left. These findings cause moderate to severe neuroforaminal narrowing on the right and moderate neuroforaminal norrowing on the left. There is indentation of the thecal sac and mild to moderate central spinal canal stenosis.

At the C6-7 level: There is a 3mm diffuse disc bulge, which is right paracentral. There is mild uncovertebral joint and facet hypertrophy. These findings cause moderate neuroforaminal narrowing bilaterally with the right being greater than the left and mild indentation of the thecal sac. There is no significant central spinal canal stenosis.

At the C7-T1 level: There is no significant disc bulge, central spinal canal stenosis or neuroforaminal narrowing.

Impression:
1.  There is mild reversal of the normal lordosis of the cervical spine with the apex centered at C5-6 level.

2.  There are disc bulges as well as uncovertebral joint and facet hypertrophy, as described above, which cause     neuroforaminal narrowing noted at multiple levels, as described above, particularly at the C5-6 level on the right. There is moderate to severe neoroforaminal narrowing secondary to the disc bulge and uncovertebral joint and facet hypertrophy. At the C6-7 level, there is a right paracentral disc bulge and uncovertebral joint and facet hypertrophy, which causes moderate to severe neuroforaminal narrowing bilaterally with the right being greater than the left.

3.  Other than minor findings, as described above.
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Avatar_n_tn
Hi, The most serious of your problems seem to be in the C5-6 level"mild to moderate central spinal canal stenosis" yet the radiologist interestingly didn't make a big deal of it in his summary,aka,Impression.C6-7 has problems too.Neurosurgeons almost always want to operate.Get a second opinion from a spine Orthopedic surgeon before you have surgery.Make sure both the neuro and spine drs are located in a big city.Ortho Drs have better personalities then Neuro's usually.Google their names and see where they trained and if anyone left feedback about them.Make sure you have copies of your mri's to bring with you.Google words from your list of impressions to learn more about them Eg. facet hypertrophy,Cervical disc bulge,etc.Numbness in the thumb,pointer and middle finger is usually carpal tunnel caused by a problem in the median nerve.For that you would need a hand/wrist othro surgeon.When did you have the EMG test done?If it was yrs ago then maybe the median nerve wasn't damaged then.Otherwise it would have showed the carpal tunnel.Did your Dr do a mri of your Thoracic spine and lower lumbar spine too?Sometimes when one is in an accident more then one area of the spine is affected.I have spinal stenosis at the Thoractic level and ulnar nerve damage of the hand.I've lost muscle in the hand and don't think it will come back.The point is to stop the muscle from more atrophy from progressing.Ask both Drs for alternatives to surgery and what the worse case scenerio would be if you didn't have the surgery.Good luck!Starmom
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