CERVICAL QUESTION

[1776]

Cervical pain, lead in, symptoms, MRI results and questions. Brief lead in information, I am a 42 yr old male. I had Spinal Fusion in 1996 of L1-S1 for severe spinal stenosis with urinary incontinence. Following the spine fusion my torso’s posture seemed to assume a slight and gradually increasing forward lean. My lower back is flat, thoracic is Kyophosis(think decrease but unsure as to exact description) , forward head tilt. A physical therapist explained to me that following a spinal fusion it was fairly common that adjacent spine segments would be negatively affected over time.  Current Symptoms: Neck pain x6 years, has increased markedly in intensity last two years(started out pain 3 of 10, now 5-6+ of 10). Neck very stiff and painful in motion, sideways is approx halfway to in line with shoulders when pain increases. Fwd flexion maybe ¼ distance towards chest pain increases.  Bending towards back pain increases after just a small degree of motion. Have frequent neck aches and headaches, If not daily, then at least every other day. Three weeks ago noticed that left arm started going numb to the fingers and then tingling pin ***** sensations. About one week after onset of left arm symptoms, right arm started same pattern. At first arms would start sensations when in straight arm or raised position, however now symptoms occur in most any position. I have woken up and had both arms numb, Both arms have also become painful in that they feel like they have been used in resistance type activity. Should I seek neuro intervention sooner over later? Thank you, Sam

[CCF-Neuro-M.D.-CS]

It would be appropriate to have a consultation with a neurologist. They can review your history and examination and help sort out your symptoms. An MRI of the spine may be needed, and an EMG test (muscle/nerve test) may also be performed. Based on the findings a consulation with a neurosurgeon may be performed. Good luck.

[1776]

MRI RESULTS FOR CERVICAL QUESTION POSTED SAME DAY by 1776:Had MRI recently that showed results as listed: Procedure –Sagittal T1, sagittal proton density, sagittal T2, axial T1 and axial gradient echo imaging were obtained through the cervical spine. Findings- There is normal signal within the bone marrow. There is disc desiccation noted at C3/4 and C5/6. There are disc bulges noted at C7/T1 and T1/2. There is normal alignment. There is normal maintenance of the vertebral body heights. The posterior elements are normal. The cord has normal signal and contour. There is no evidence of cerebellar ectopia. There is normal signal within the CSF. Structures anterior to the spine are normal. AXIAL IMAGING: C3/4-There is a broad based disc bulge. There is moderate central spinal stenosis with mild to moderate bilateral foraminal stenosis. C4/5- There is a broad based disc bulge. There is mild central spinal and moderate bilateral neural foraminal stenosis. C5/6- There is a broad based disc bulge. There is mild central spinal stenosis and moderate right and mild left neural foraminal stenosis. C6/7- There is a broad based disc bulge. There is mild left greater than right neural foraminal stenosis. C7/T1- There is a disc protrusion eccentric to the left. This causes severe left neural foraminal stenosis. There is no right neural stenosis. There is mild left neural foraminal stenosis. T1/2- There appears to be a broad based disc bulge possibly causing mild central spinal and bilateral neural foraminal stenosis, not well seen. The protrusion noted on sagittal images is not well seen. IMPRESSION:  Degenerative changes as above, most significant at C7/T1 with a left paracentral disc protrusion causing severe left neural foraminal stenosis. Thank you, Sam.

[1776]

Can you elaborate on the MRI results. Thank you, Sam

[1776]

Request that you address previous question/answer in lieu of posted MRI results. Thank you, Sam

[ccfneuromd]

Without reviewing the films I cannot make an accurate statement. Based on the report there is degenerative changes at multiple levels, the most severe at the C7-T1 level on the left. This would affect the 8th cranial nerve which does suppy the muslces in your hand/forearm and could cause sensory changes in the hand/forearm. A neurologic examination is critical to determine what nerves may be affected, and to see if the MRI explains your symptoms. Good luck.

[1776]

The initial MRI was without contrast, would an MRI w/contrast provide any further assistance? Also, I am familiar with EMG/NCS studies, but what is an SSEP study and would it provide any valuable diagnostic information? Thank you. 1776

[catlover10]

A related discussion, nerve pain after 4 surgeries for spinal stenosis was started.