Cord Compression

[Zacksmom]

My MRI report states the following:
Broad based central disc protrusion at C5-6 with mild ventral cord flattening.
Right paracentral smaller disc protrusion at C4-5
Minimal disc bulge at C6-7
Loss of normal signal within L5-S1 disc.
There is broad based central disc protrusion and annular tear at L5-S1
I have been having weakness and numbness in my right shoulder and arm, with numbness in my pinkie and ring finger.  My right leg from the knee down has similar symptoms.  I was terrified of ALS when the symptoms started, but now feel that the MRI suggests other causes.  Can what is going on in my back cause these symptoms?  Also, can rehab/therapy remedy this or is surgery a "have to"?  Thanks so very much!

[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.    
   The symptoms you describe are non-specific and may or may not be caused by the MRI findings that you describe.  I agree that your symptoms do not sound like ALS.  "Mild ventral cord flattening" could be a cause of your right shoulder/arm/hand symptoms, but many people with this finding have no symptoms at all.  The same applies for the disc protrusion/annular tear at L5/S1.  You need further testing to evaluate the specific cause of your symptoms (although the MRI was a good start).  Your next test should be an EMG (nerve-muscle test) to determine if you have nerve root compression causing your symptoms as your MRI would suggest.  I would also recommend that you get a SSEP (somatosensory evoked potential) to assess whether the "mild" cord compression reported on your MRI has any functional consequences.  I would also recomend that you see a neurologist and get a full exam to assess whether any other testing may be needed.  It is to early at this point to predict the best treatment for you, but many people are helped with physical therapy and time, while others need surgery (annular tears tend to get more surgery).  
I hope this has been helpful.

[mike1105]

firstly, i am not an MD, although I'm familiar with MRI teminology due to reading so many of my own. Your MRI does not sound that bad to me. Most people by their 40s have developed similar findings. A huge percentage of disc herniationss do not cause symptoms. just becaaue there is a "finding" on your MRI does not mean these findings are causing symptoms. Besides, the 5th (pinky) is innervated by the ulnar nerve which arises from c7/t1 if i am not mistaken--and your report does not mention this level. You may have cubital tunnel syndrome (ulnar nerve entrapment at the elbow).  I'd see a neurologist and have nerve studies done (EMG). you need to find out if your leg symptoms are related to your arm/hand symptoms, which would suggest a more general problem as opposed individual compression syndromes.

[Jewel529]

Just curious, where do you get your information and how do you know so much? Do you have any medical background at all? I see that you post on here a lot and you seem to know medical terminology. I have had 2 cervical MRIs done, 2 EMGs, shoulder xray, shoulder MRI, abdominal US, chest xray and very regular mammograms and breast US done, ALL because I have had chronic shoulder, neck, arm, upper back and upper chest pain for 2 yrs now. For a very healthy person who is in good shape to start having chronic pain that no doctor is able to figure is unbelieveable to me. I read these forums a lot, which probably doesn't help my pain because I am sitting in front of a computer, but just knowing that there are other people out there in the world that actually describe what you are going through is almost, well, comforting, I guess. You know what I mean? Your input is very interesting to read!

[mike1105]

jewel-- why don't you email me at ***@****. Your pain is EXACTLY what I had. If the cause is the same (and I'd bet it is since all your tests were negative--lol, like mine were !! ) I can help you get pain free.  email me and I'll give you my 2 years of research (and the answers that worked) in 10 minutes.

[slipnslide]

Zacksmom,

I partly agree with Mike, but in the same breath, I will state that I partly disagree.  Your C4-5-6 protrusions do explain your shoulder/arm pain.  Yes the ring and pinkie fingers are innervated thru the c8-T1, the ulnar nerve.  Muscle tightness or inflamation (inflammation) in the shoulder area could compress the ulnar nerve along it's path.

The L5-S1 loss of signal and annular tear is a definite sign that the disc is leaking and irritating the nerves causing your leg symptoms.  A good website to visit would be http://www.chirogeek.com/
it has alot of good information that may help you understand better.

Here are the cervical nerves:

CERVICAL PLEXUS (C1–C4)

C1
Motor to head and neck extensors, infrahyoid, rectus capitis anterior and lateral, and longus capitis.

C2
Sensory to lateral occiput and submandibular area; motor, same as C1 plus longus colli.

C3
Sensory to lateral occiput and lateral neck, overlapping C2 area; motor to head and neck extensors, infrahyoid, longus capitis, longus colli; levator scapulae, scaleni, and trapezius.

C4
Sensory to lower lateral neck and medial shoulder area; motor to head and neck extensors, longus coli, levator scapulae, scaleni, trapezius, and diaphragm.
   BRACHIAL PLEXUS (C5–T1)

C5
Sensory to clavicle level and lateral arm (axillary nerve); motor to deltoid, biceps, biceps tendon reflex. Primary root in shoulder abduction, exits between C4-C5 discs.

C6
Sensory to lateral forearm, thumb, index and half of 2nd finger (sensory branches of musculocutaneous nerve); motor to biceps, wrist extensors, brachioradialis tendon reflex. Primary root in wrist extension, exits between C5-C6 discs.

C7
Sensory to second finger; motor to wrist flexors, finger extensors, triceps, triceps tendon reflex. Primary root in finger extension, exits between C6-C7 discs.

C8
Sensory to medial forearm (medial antebrachial nerve), ring and little fingers (ulnar nerve); motor to finger flexors, interossei; no reflex applicable. Primary root in finger flexion, exits between C7-T1 discs.

T1
Sensory to medial arm (medial brachial cutaneous nerve); motor to interossei; no reflex applicable. Primary root in finger abduction, exits between T1-T2 discs.

Best wishes,

Kim

[mike1105]

her report reads "mild" protrusion and "minimal" cord flattening in the neck. This actually sounds like a pretty favorable MRI report to me !! I seriously doubt these findings are causing her upper extremity symptoms. (The lower annular tear and loss of signal is potentially worthy of a correlation to symptoms, and warrants further investigation).  Again, just because there was a "finding" at c4/5  does not mean that this finding explains her symptoms, and neither would it explain things if the innervation of the level of the "finding"matches up with her symptoms. (actually, it does NOT even match up---the pinky is not c4/5). this is a huge and potentially disastrous leap of thinking to make---could lead to unnecessary surgery/injections etc. More than likely shoulder/arm/finger  issues are of soft tissue origin in my experience.
This is a huge problem in general---- most people (even some MDs but especially laypeople) do not know how to interpret these reports. There are many older folks whose spines radiographically are a complete mess, but have no symptoms, and dont need any treatment at all. Relating the poster's arm shoulder finger issues to her MRI report like you did is like stating that someone is a diabetic and needs insulin becasue they were seen in dunkin donuts. well-- you get my drift....

[slipnslide]

Mike,

I respect your opinion.

Zacksmom,

Find a good Neurosurgeon or Spinal Orthopedic Surgeon that is board certified and preferably highly recommended. In my experience, having seen both, neither will operate based on pain, they operate to correct stability issues and neurological issues. It's a good idea to get at least 3 surgical opinions before deciding on surgery (if they recommend it once you see them.)

I've attached a link to a dermatome chart that shows what dermatomes correlate with what spinal levels.

Regardless Zacksmom, you know your pain and how much you can tolerate, push them to find what is causing it before it becomes chronic.  I hope you get some relief soon.

http://www.apparelyzed.com/dermatome.html

I wish you both the best,

Kim