Cervical Stenosis, Spondylosis, Annular Tear and Scoliosis in Thoracic Spine

[INGRASS]

I have posted before on 09/01/06 and 09/30/06.

I have recently returned from my follow-up appointment at the well respected place and have absolutely wonderful news.  There is NO progression of my stenosis from last year and in fact, I was told that there is a very good probability that I will never need surgery for any of my spine issues.  Words cannot express how wonderful this was to hear.

I had an appointment there with the neurologist that I saw last year and then the mri of my cervical and thoracic spine. I had a brief follow up appointment with the same neurologist the next day. I did not post the new mri pictures this time as I haven't received the CD and as you said, the quality from the CD is pretty poor.  Here's the new mri report though:

13Nov2006  4:11pm  Exam:  MRI CSP & THSP wo
Indications:  mri cap/tap - spinal stenosis^cervical; pain thoracic spine.
ORIGINAL REPORT - 13 Nove 2006 4:36PM   GONDA
MR cervical and thoracic spine without contrast.
Stable when compared to prior evaluation dated 10/19/05.
Reversed lordosis, apex at C6.  Spondylotic changes at C3-4 through C6-7, with moderate to severe central canal stenosis at C5-6 and C6-7, due to osteophyte disk complex, and without cord parenchymal signal change.  Mild to moderate left neural foraminal narrowing at C6-7.  Remainder of the cervical examination is otherwise unremarkable.
Focal annular tear at T7-8, with disk material contacting and without deformation of the ventral cord.  Mild endplate osteophytic changes at T3-4 and T4-5, result in mild effacement of the (con't below)

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

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
I am glad to hear that your spinal stenosis has not progressed.  Your current MRI report relates significant stenosis without a pathologic signal changes in the spinal cord.  When stenosis progresses to pinch the spinal cord this can lead to pain, weakness, numbness/tingling and even bowel/bladder incontinence.  If you develop these symptoms (especially the bowel and bladder incontinence) you should have new imaging as soon as possible.  Foraminal narrowing as noted on your MRI can lead to problems if significant enough such as pain, sensation changes and even weakness.  Focal annular tears are a common cause of chronic back pain, that is often refractory to treatment.  You post relates "(con't below)", but I am unable to view the rest of your post.  I am sorry if I did not address any further questions you may have posted.  In addition, your previous posts are no longer loading (?)
I hope this has been helpful.

[INGRASS]

subarachnoid space.  The thoracic cord appears intrinsically normal.

So, with this great prognosis, I am ready to get on with my life.

I am currently being offered a full-time job (which I have actually been doing for 2 weeks on a temporary basis) and am ready to accept the permanent position.  The position requires sitting at a computer all day.

The reason that I am writing is due to the fact that I am still experiencing the significant pain and muscle spasms in my mid to lower back that I previously wrote about.  The pain is there daily and brought on by sitting.  It started suddenly and I have had it for about 6 months now.  It is interspersed with burning and stabbing pain and is not being completely controlled despite 1000 mg of Relafin, 8 mg of Tizanidine, 60 mg Cymbalta and the Tylenol that I have been supplementing all of this with.   I have also continued to utilize the new therapy pool at our local YMCA several times a week.

The pain is interfering with my decision to accept the position and I would really like to find out the cause of it so that I may seek appropriate intervention without the need to take yet another drug.  There is some possibility that I can delay my start date as the company's hiring season runs from January through March.

The neurologist at the well respected place told me that the pain was not coming from anywhere in my spine and the thoracic issue, in fact, did not even need to be followed.  More great news!

Since my spine has been ruled out as the cause of this back pain and muscle spasm, could you possibly tell me where else this pain could be coming from?  What other systems could be generating it?  What type of doctor might be able to help me figure this out?  

Thanks so much.  I very much appreciate your responses.  

[mike1105]

its gotta be muscular in origin. get some books on strengtheneing your core, and posture. i recommend jolie bookspan's website for you.

[INGRASS]

Hi Mike,

I've printed out a lot of the material on Dr. Bookspan's website.  Looks like I have a lot of work to do!  Thanks.

[INGRASS]

I apologize for adding to this post and understand if I have asked more than you are able to provide.  It is just nice to find someone willing to answer questions.

Here is part of the neurologists notes from my two recent visits:

As recorded on electronic neurologic record of November 13, 2006, She is right-handed, alert, oriented and displays normal language and conversational speech.  Cranial nerves 2 through 12 are unremarkable.  No carotid bruits.  Muscle stretch reflexes are moderately hypoactive in the upper extremities, but they are symmetrical.  In the lower limbs they are normal, reactive and symmetrical and plantar responses are flexor.  On general motor survey gait, station, coordination, and alternate motion are normal.  No tremor dystonias.  Good range of motion of the cervical and lumbar spine.  No paraspinal spasm.  Muscle strength is normal  There is no muscle atrophy.  Sensory examination is unremarkable.  

MRI of the cervical and thoracic spine were obtained and compared with the previous MRI of 10/19/05.  The findings have remained stable.  There continues to be moderate to severe central canal stenosis at c5-6 and c6-7. There is no cord signal abnormality.  Focal anular tear at t7-8 is seen with disk material contacting but not deforming the ventral cord.  All has remained stable.  

I have recommended repeat MRI in 18 months if all remains stable clinically.  The situation should be reassessed earlier if any new developments or concerns should arise.

Ok, now for the questions:

The neurologic exam record shows -2 (on scale of 0-4) on both left and right sides for each of the following reflexes:  Biceps C56, Brachioradilis C56, Triceps C678.  Thoracic was not tested but everything else that was was normal.  

Does this mean anything?  I don't remember any problems noted in last years neurological evaluation done by the same doctor. Does it mean progression or does the fact that the reflexes are symmetrical make this insignificant?

Also, how can one MRI say the the foramen are widely patent and the next year's MRI say that there is mild to moderate left neural foraminal narrowing at C6-7? I actually have yet another MRI report from 2001 that says there is moderate foraminal narrowing at c5-6.  So...they are narrowed, then they are widely patent, then they are narrowed but at a different level.  This is VERY confusing.  What do I believe and what is the significance of this anyway?  I know the nerves exit here.  

Does the material up against the cord sound like it is from an old tear that has healed itself like I was told?

What do you feel the chances of never needing surgery are?

All comments are welcome.

Thanks.

[mike1105]

i seriously think you are barking up the wrong tree here. If you continue to delve into the details of your MRI reports you'll get nowhere, but you will go crazy. Findings like "narrowing" and even "stenosis" are to a degree highly inconsistent from one radiologist to the next. I've been there. If I were you I'd put those reports away, and concentrate on fixing yourself. If you had something wrong enough in your spine to require surgery your doctors would have told you. Your symptoms are classic for weakness in the muscles of the mid/lower back. You need to strengthen them with proper exercise and stretch them appropriately. NEVER NEVER let anyone operate on pain. It makes no sense. Your MRI report comes nowhere near calling out for a surgeon to intervene. Your problems sound postural and muscular to me. see a website by Jolie Bookspan, order her book THE AB REVOLUTION or another one about fixing your back without surgery. Her methods and information gave me my life back. It may take a while, so dont be discouraged. Sit up straight!! dont hunch!!

[mike1105]

5 days after you printed bookspan's info, you posted a long dissertation on your MRIs. Why? did you start the exercise? 3x per day? or did you get lazy and figure there has to be a way for SOMEONE ELSE (A DOCTOR OR SURGEON) to fix you? do the exercises 3x per day. stand up straight ALL THE TIME. sit up straight. Dont hunch. If you follw this regimen you'll feel better soon. It took me 4 months, but now my mid back pain is gone (unless I hunch at the computer for a few hours). Pick yourself up by your bootstraps and realize that looking for someone else to help you will not get you anywhere, except perhaps on the operating table unnecessarily-- which may really screw up your life.

[INGRASS]

The "long dissertation" was for the benefit of the CCF Doc.

Just because YOU went whining and complaining to every doctor you could find until one would operate, that doesn't mean all of us are that dumb.  I KNOW I don't need surgery at this time.  Stop insinuating that I think I do.  

You seem to be very angry at the mainstream medical community.  Why?  Why are you so insistant that they have nothing to offer any of us?  

I've got a really good neurologist, Mike, whose advice I am following regarding the big issues like surgery,  but he is 6 hours away and is only following the progression issue, not treating the symptoms. He had me see one of the country's top neurosurgeons last year.  

Even so, I'm not entirely sure that my thoracic problem has been thoroughly investigated.  I CAN tell you that the pain is significant.  When I asked about it, he said "for all we know, that could be something old that has healed itself".  I know that he is limited in the kinds of diagnostic tests he is allowed to order at this facility.  Certain ones can only be ordered by the surgeons, which I did not see this year.  I did not have the thoracic symptoms last year.  

This forum is for educational purposes and that is why I posted.
I am looking for information in order to help myself.  We don't even have a full time neurologist in my immediate area, so this forum has been very helpful.  If I was "lazy" like you have said, I would have taken my local gp up on his offer for narcotics, don't ya think?

[mike1105]

im just trying to motivate you thats all. and you never did answer my question.. did you start the exercises and stretching? your problem to me sounds muscular-- there is nothing on your MRI report to indicte other wise. no one else will e able to help you if I am right. It still hurts after you leave the neurologist's office, doesn't it?  I am not angry with the medical community-- I am a doctor myself. We are trained to order test after test when we cant diagnose something so as to cover our asses. It's frustrating. Myofascial pain is the scrouge of mankind. It hurts "significanly" as you said-- so much so that it is almost impossible to believe that a doctor cant find the problem and cant help. There is no "test" to diagnose it. There are too many surgeons out there who will operate on pain if a patient seems desperate enough, for they are uneducated about myofascial pain. And believe me they will cover their butts in their written records. believe it or not i want to help you still. take a leap of faith, read up on this stuff and go fix it.

[mike1105]

PS-- to me, the line "for all we know this could be something old that healed itself" is typical verbage from a doctor who does not know why you have pain. if it's healed, why does it hurt? I'm sure he'd have an answer to that question---something like  "probably scar tissue buildup around the nerves" or something similarly non distinct (and of course non treatable). I do wish you luck. I've told you all I can.

[INGRASS]

"There are too many surgeons out there who will operate on pain if a patient seems desperate enough, for they are uneducated about myofascial pain."

You are correct in giving this advice, Mike.  When I was first diagnosed last year, after he got the surgeon's opinion, this is one of the main things that the out of state neurologist wanted me to understand.  

As I said, he is very good and extremely intelligent and on top of this is just a very caring human being.  A real people person who is also a professor and clearly loves to teach.  It is probably some of the most important information he could have given me.  

He found a way of making me understand that the surgery was only designed to prevent further cord damage (which I do not yet have).  He, of course, is most concerned about my cervical spine and was even more so before he knew if it was stable.  I feel fortunate that I landed in his office for my initial diagnosis and not in one of those other guys offices.  

So...I have to deal with the symptoms, I know.  The local neurologist won't see me until April, but is pushing for me to see a needle jockey.  My gp wants to give me narcotics. Several friends have suggested acupuncture. The good neurologist says not to let anybody manipulate my neck or put me in traction, and on and on. GEEZE!

All I want is to figure out what will help the pain so that I can get on with my life, pray that I don't hurt my neck again ("no elbow room there") and follow my neurologists suggestions about the need for observation.    

Thanks for your offer of continued help.  I have never met you, so it was difficult to ascertain your intent from reading your words, but you could be on to something here.  I guess it won't hurt to actually try the exercises I took the time to print out.

Something in one of your posts made me think that you might be from Illinois.  Are you? I am 90 miles SW of Chicago.

[mike1105]

i live in florida. ingrass, you said your pain is in your mid and lower back, right? and that it is brought on by sitting, right? everything I've learned in school or read in my life tells me this has little or nothing to do with the findings in your neck and everythng to do with muscle weakness/imbalance/spasm and postural issues. You may need periodic (perhaps yearly) checks with a neurologist regarding your cervical MRI findings, but the pain in your mid and lower back, I would bet the farm, is MUSCULAR, ie has nothing to due with any hard tissue (bone) compression in the spine !!!! Take a leap of faith. Do the approprite stretches and exercises you printed out. get a book on posture. I had all the same problems as you. I was in agony. Utter agony for the better part of 3 yrs. I fixed it myself-- it took 4-5 mnths.. I want you to do the same.

I actually traveled to Chicago to meet with a myofascial therapist named Sharon Sauer, who was the assisstant for many years of Janet Travell (she has passed on), who wrote the bible on myofascial pain/triggerpoints and used to treat JFK, among others.-- I would highly receommend you see her. you can contact her office through Myopain.com. She's great. absolutely great. No one understands this stuff better than her. There is a common sense, understandable explanation for your pain, and I would bet she can explain it. It's not overly expensive either. I stayed in the area for a week and saw her twice daily. good luck.

[NURSELPN]

Sorry ro butt in here...If I could please ask you a question it would be appreciated.

I am a 55 yr. old female. I have a hx. of graves disease w/ thyroid eye disease & Vit. B-12 deficiency.

Since 06/06, I have been suffering with pain on inside border of my left scapula, also in the back of my lt arm running down into the back (ulnar) region of my forearm & at times in my last two digits of my lt. hand. The pain is intermittent & a 7-8 on a scale of 1-10. The area along the posterior side of my left axilla & back of lt arm is even tender to touch most of the time.  This pain, to me, seems to run down where the ulnar nerve would run. I had an MRI of the cervical spine in 06/05 (1 yr. earlier)for a neurology workup, for numbness, when B-12 deficiency was found. The MRI w/o contrast showed minamal buldging annuli without superimposed disc herniation at C-5,6, &7. The neurologist said this was normal for my age at that time.

I had rt eye surgery in late March for TED. Inially when this lt scspuls & lt arm pain started in April of 06, I seen a chiropractor because I thought I had irritated or pulled something when I was doing spring cleaning.  NOTE: I had also been tilting my head to the right to correct my double vision after surgery. My family doctor referred me to a ,psyiatrist (splg?), physical medicine doctor, who  gave me a trigger point injection, inside my lt. scapula, which seemed to resolve the pain, temporally. I had another eye surgery in July & my pain returned with a vengence. It still remains after  physical therapy, exercise, ultrasound & hot packs, & multiple trigger point injections. I have finally had most of my eye surgeries & my double vision (which I thought my tilting my head to the right was aggravating my lt arm pain) is much improved but the nerve pain continues. Now my psyiatrist says he feels I have cervical spondylosis & has given me cervical traction, a muscle relaxer & Vicodin to use. He told me I had a bone spur in C-5,6,or C-6,7 which is hitting against a nerve causing my pain. I would like to have another MRI done to make sure there has been no changes since 6/05. This pain started almost a year after that MRI & it seems like he is diagnosing me by S/S alone. How can he be sure his diagnosis is correct without further testing? Nothing seems to be helping.

I've been a nurse for over 30 years & I have a bad feeling about this. Am I just imagining things. I don't like being the patient,
I know that.

Thanks for your time, TJ

[NURSELPN]

I'm sorry for all the spelling errors, when I re-read my post I can't beleive how many I misspelled. I hope you can understand it OK. I guess I have brain fog....:-) this morning.

Blessings, TJ

[NURSELPN]

Mike,

I was reading some of the prior posts & found your comments under, numbness in pinky/ring chest wierdness (not pain/pressure), on 12/19 I beleive. I am also seeing a hematologist for what could be polycythemia vera. In my first pre-op testing, in March of 06, I had  leukocytosis, thrombocytosis, neutrophilia. My family physican re-checked it two more times & noted it continued & referred me to a hematologist. He continues to monitor it & will do a bone marrow biopsy in the future if he feels it's warranted. He says the treatment is the same whether it's polythycemia vera or just idopathic & that is blood letting. He said it has been caught early & we need to just monitor it at this time. I just thought it was amazing that polythycemia vera was mentioned in the post below. It's pretty rare.

TJ

[mike1105]

nurselpin-- i guess i may be sounding like a broken record but here's my take-- keep in mind i havent seen you, i am not an md, (im a dentist) and this is just my opinion from personal experience. Many doctors are too quick to say that muscle or arm pain or scapular pain is from a pinched nerve. this may be possible, but to me in your case it sounds more like trigger point problems stemming from shortness and tightness in the MUSCLES in your neck. get a book by clair davies called the trigger point manual. Judging by what you said about leaning your head to one side, i can say from what i've learned that it is entirely possible, if not probable, that this triggered spasms in the muscles of your neck, especially the scalenes, the traps, and maybe even the pec minors in your chest. when these muscles are short, tight, and in spasm, your back muscles (like the rhomboids between the scapulas) try to compensate and they too spasm becasue they are not strong enough. the arm pain in this scnario comes from a nerve beng pinched by MUSCLE tightness around it, or postural problems.--try this--- massage the heck out of your scalenes (use the manual for this) for a week. press and hold where it hurts. try to keep your posture good by making sure your ears line up with the middle of your shoulders (side view)when you stand. also keep your shoulders pulled back---- stand up against a wall with heels, butt, back, and back of the head touching the wall..... this is correct posture. stay like this all the tme for a week- also stretch your chest muscles by doing a doorway stretch (look it up on the intenet). do all these things for a week-- dont even try to massage your back. your back should begin to feel better becasue it wont have to work so hard once your neck is fixed. see if you feel better after a week. give it an honest 100% effort-- 1 week let me know. ill check

[mike1105]

ps there are also neck stretches you can try. look them up on the internet and concentrate on the scalene and upper trapezius stretches.

[NURSELPN]

Thanks Mike,

I will definitely do my best to try what you suggested. I've lost so much strength in my large muscles with this graves disease & immobility the past couple of years. I can't beleive how much a disease can effect a person. I also have B-12 deficiency & what ever it is (with my blood...polycythemia vera?, high RBC's, WBC's,Neutrophils, hgb, hct. The jury is still out on that. All of these cause fatigue & that hasn't helped.  I was actually a very health individual. Worked full time as a nurse & was very active. Up til 4 years ago & it's been non-stop since. But this year is going to be better, right.

Thanks alot, my best to you.
TJ

[INGRASS]

I just found a fantastic site while researching where the scalenes were.

www.realbodyworks.com has charts showing all the muscles and much more.  Just click on the word muscles at the top and then pick your desired muscle group from the list.  A chart showing those muscles shows up along with info regarding what they do There's a lot of information on this site regarding myofacial release, trigger points, etc.  I've already got it bookmarked.  Its definately a keeper.

[INGRASS]

Whoops...leave off the s.  Its realbodywork.com