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myelopathy
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myelopathy

I did ask a previous question, but since my symptoms are worsening, I would like to ask more advice.  I had an anterior cervical fusion c4 - c6 in 2000 after I fell from a horse, was refused posteriorly in 2002 from c4 - T1 in July 2002 after my symptoms came back. Did well postoperatively until November 2002 when I developed spasms, frequency of urine again. Was admitted for IV anti-inflammatories and physio(I am on a physio program for almost a year now) MRI showed a central disc prolaps c3c4, but the dr. decided not to operate.  In December I started having fasciculations R upper leg and R arm.  These fasciculations are more widespread now (especially upper legs, both arms and back - sometimes even in my face). Also have severe stiffness of the neck and throat muscles and urine frequency- especially when the activities at work increase - I am a unit manager of an ICU.  I saw the neurosurgeon again, he did not rescan, but referred me to a neurologist for electrophysiological testing. I have an appointment to see him in March.  The dr suspect me having a cervical myelopathy caused by the trauma.  My question is: can these symptoms be caused by the myelopathy, or does the disc prolaps c3c4 play a roll, and if it is a myelopathy, what is the prognosis?  Thanks for the time.
Hettie
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First of all, it's unlikely that the fasciculations are related to the cervical spine problems as you're having them in the face as well as other places outside of the cervical root/segment innervated muscles. Could be benign fasciculation syndrome depending on your clinical history and exam. Second, bowel and bladder changes are worrisome for myelopathy, but the remainder of the physical exam is also important in establishing it as a diagnosis such as the briskness of the reflexes, muscle strength, sensory findings, etc... If it is a myelopathy, prognosis depends on what's causing it.  If it's something treatable like a disc pushing the spinal cord that can be removed, that of course portends a better outcome.  If it is caused directly from the trauma and there is significant damage to the spinal cord, then over time the cord will gradually start to atrophy resulting in slowly progressive weakness in the regions that have been affected.
Third, not sure if the C3-4 disc prolapse is really a significant player as I have not seen your MRI myself and don't know the degree of severity. But usually if there's a nerve root being pushed on at this level, you'd get some kind of sensory changes at the level of the jaw and neck with muscle changes in the proximal shoulder and back muscles. An EMG will be helpful in this regard, but I would all recommend a full neurological examination by a neurologist to help you figure where the problem is. Consider a second opinion at a major academic center or stick with your current neurologist if you have one you like. This is a complex case that requires a sit-down discussion and question and answer seesion with your docs. Good luck.
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Hettie

Your symptoms of myelopathy are caused by compression, an MRI should show where/what/how. It sounds as if your disc protrusion is the likely candidate, otherwise osteophytes may be causing compression of the nerves and or artery/veins. Your symptoms are exactly the same as mine, though my fingers are affected badly with shooting pains, it has become difficult to use them and software which you can teach to type for you may well help you if your hands are afflicted.

Like you my leg is affected by weakness and because your balance is off you will sometimes not know when you are putting your limbs, an example was when I fell backwards on a moving staircase because I thought someone had called my name, my neck and shoulders moved around but took my whole body with it. You become clumsy and have a staggering gate, falling to the side occasionally.

The disruptions to the body are many, the eyesight can be affected and the hearing, at first tinnitus is thought to be the cause but as the jaw and head is affected you will find that dentistry work can be difficult, and swallowing. These things are often put down to anxiety, it's all in your head - sure it is - its all in the nerve connections, even vibrations can set off the shooting pains, weakness, numbness, pins and needles, not to mention anyone putting a hand on your neck or back as if to gently pat you, the pain from that is excrutiating.

Try explaining all this to people, they think we are daft. I don't know how you manage to stay working I had to give up a year ago after a nasty experience lifting and then another unpleasant experience with an NHS physiotherapist.

I now go to a private physio who gives me ultrasound on my lower back ligaments that are wrecked in order to keep my left leg weakness and lower back pain under control, anything to keep on my feet. I wanted to see a neurologist a year ago but had to wait a year to see an orthopeadic surgeon who rubbished my pain and fingers which are disfigured.

It may at the end of the day be 2 different things wrong with me, but the shooting pains shout out nerve compression to me and I am only a Phlebotomist. I get my first MRI scan this Friday coming, so should know more soon, unfortunately it is the ortho surgeon I will be seeing again sometime after the scan, and I think you can tell I don't trust her. Trust is so important.

I am so surprised they did not want to operate on your disc, by not doing so they have allowed the compression to continue to develop into myelopathy. Scar tissue would be my concern from the site of the injury and disc prolapse. However, we have enough to worry about with the bladder incontinence that myelopathy causes, I think sometimes they hope and wish we will get better in time with surgical procedures, I often wonder that if they operated 14 years ago to remove the extra cervical ribs then maybe myelopathy would not have developed. We will never know.

I hope you will continue your quest to see what your options are surgical or otherwise, and not let them palm you off because they won't admit they don't know. Even if they would say they could operate but that might not make your myelopathy go away, at least that would be honest, and over to you for consideration. The medical proffession is so frightened of being sued these days that they won't say 'sorry-made a mistake' or 'i don't know'. Sad!

I remember my friend who lives in New York telling me recently about the doctors complaining about insurance for malpractice, surely it should be the same as my car insurance, if I make a mistake I pay for it through my insurance, maybe doctors should have 'no claim bonuses' and the cost should go to those who have to use it much, instead of being priced across the board. We all make mistakes, it is easier to bear with a sincere apology and the best aftercare. When a physio fractured an osteophyte in my neck it was quickly covered up to the extent that the xray I was shown in casualty was not one that I later was sent when I requested copies of those xray's. Since then I have been labelled a liar that it did'nt happen, yet the doctor in casualty wrote to my own doctor stating there was a fracture. Now its a case of 'prove it'. Try proving it when the xray isnt there anymore, or at least not available to me. My doctor has taken early retirement disillusioned with the NHS politics, this was not what he became a doctor for.

I hope you will keep fighting on and let me know how you get on.

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The jaw jerk controlled by the fifth cranial nerve is checked by tapping on a slightly opened jaw, a normal reflex contraction of the masseter rules out pathology above the foramen magnum.

Parethesias or leg weakness is exacerbated by neck flexion. Men show problems here when attempting to urinate.
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Annabel, thanks for your comments.  It helps to know that there are other people out there to share with.  I am having an appointment with a neurologist on the 18th March.  The uncertainty of what can be wrong is really troubling, but at least it is not so long anymore.  If one can just know what is wrong, then I can let it be treated or make peace with it.  Being in pain most of the time and experiencing all these symptoms can be very depressing, but in the type of work I'm doing, I can't allow myself to be depressed.   I will let you know what the findings of the tests are.  In the meantime: hang in there!
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Do you mean to tell that if I have a Herniated Cervical Disc in my neck (I have two, C4-5, C-6-7) that the reason my right leg and foot have been going to sleep(pins and needles sensation) can be the result of my spinal cord flattening?

I'm gathering that a Neck Herniations can indeed cause a problem with the leg and foot.  

How does that happen? I thought I hurt my lower back but I am certain that never happened.  It's so bizarre.

FlyHigh
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Hi Hettie - hope you get your diagnosis, you're right that knowing what you have is the best present a doctor can give you, it takes away the imagination and fear, it gives you a way forward, in effect it sets you free, from there you know your way forward.

FlyHigh - Cervical Spondylotic Myelopathy presents with the following symptoms as a general rule:-

Weakness, nymbness/clumbsiness of upper extremities (arm/s, hand/s, finger/s)


Altered walking ability perceived as either poor balance, weakness, heaviness or numbness in legs

Painful stiff neck

Variable degrees of radicular arm pain

You may have stabbing or burning sensations and/or persistant dull ache, pins and needles extending to fingers
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C4-C5 (C5 nerve root) -can cause weakness in the deltoid muscle in the upper arm, can also cause shoulder pain.

C5-C6 (C6 nerve root) -weakness in biceps (front upper arm) and wrist extensior muscles. Numbness/tingling may radiate to thumb. Very common in cervical disc herniation.

C6-C7 (C7 nerve root) -weakness of triceps (back of upper arm extending to forearm) to finger extensior muscles. Numbness/tingling triceps to middle finger. Also common in disc herniation.

C7-T1 (C8 nerve root) -weakness of handgrip. Numbness/tingling down arm to smaller fingers of hand.

We are all wired up differently, this is a guide.
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Hope to hear from you soon Hettie. I am awaiting my MRI cervical scan results and will be seeing a neurologist on the 27th March after a very long year and a half wait to see an orthopaedic surgeon, but that's the NHS for you, their philosophy is that if the patient has'nt gotten better or died before the appointment then an appointment was'nt required anyway. Sort of spoils a patients 'fighting chance' of good surgical recovery, which is the case when diagnosed sooner rather than later, but then after 14 years of neck/shoulder pain you become used to pain and finally disability; sad but true. I prefer your method of healthcare in the US but of course would like healthcare available to all. In Britain we have a good service for the few who can afford to go private and a poor service for the masses. But hey! did'nt mean to get political, just always wondered why we over here can't 'opt out' of the NHS to pay private health insurance instead of paying for both, after all we all pay for our dental service here, well! if we want to keep our teeth a long time we do, but that's another story and I promised not to get political-ha! Just my British sense of humour guys!
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Hettie - forgot to say that I have had jawpain for many years in front of the ear on one side, always ignored by the medical prof. so I have to assume that it is part and parcel of osteoathritis, it can make dental treatment difficult sometimes, the jaw-jutters if it has to be open for a long time. The click on opening the jaw has always been quite loud and can be heard by the dentist, I was once offered ultra-sound for it but it never happened, if you chose to have ultra-sound make sure that you don't have osteoporosis because it is not recommended for that condition. I used to laugh at one dentist I had, he would beg me not to open my jaw while he was within earshot, I did it just to annoy him, but he took it in good humour, humour is a saving grace.
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Hettie and Flyhigh

My MRI on cervical just shows narrowing at C6 otherwise normal, nothing said about the extra bilateral ribs. I'm now even more puzzled as to why I have the shooting pains from my neck branching out to my shoulder and shooting pains in my fingers which are bent up at ends, as well as the other problems. These results were given to me across the phone, I still have to see the ortho again and soon I'll see my first neurologist. Now I'm even more confused than ever. Will keep you informed. Hope you are both keeping positive.

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