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Hi all,

I am a 45-year-old female who was diagnosed last year with spinal stenosis and spondylosis without myelopathy and will soon be returning to the out of state clinic that diagnosed me for a recommended follow up mri.

Because of additional spine problems found by local doctors since my diagnosis last year, I would like some suggestions regarding what questions I should ask of the neuros at this upcoming appointment. Thank you in advance to anyone who replies.

Here is the radiologist's report from last year:

Result: Report Date: 19 Oct 2005 6:06PM MRI of the cervical, thoracic and lumbar spine without IV contrast. Cervical spine: Congenitally narrow cervical spinal canal. Moderate spondylosis in the mid/lower cervical spine with associated degenerative disk disease and narrowing of the C5-6 andC6-7 interspaces. Disk osteophyte complexes at C5-6 and C6-7 cause marked narrowing of the spinal canal. No abnormal T2 signal identified within the spinal cord. Cervical neural foramen are widely patent. Thoracic spine: within the thoracic spine,there is an anular tear and small focal disk protrusion at the T7-8 or T8-9 level which partially effaces the ventral subarachnoid space and minimal deformity of the ventral spinal cord. No abnormal cord signal identified. Between the scout aquisition and the images of the thoracic spine, the patient appears to have moved slightly, therefore, prior to any surgical intervention within the thoracic spine, further imaging is recommended to definitively determine the level of the above findings. Lumbar spine: Lumbar spine normal with no significant spinal canal or nerve root compromise.

I had an emg last year which came out fine, although most of it was done on the left leg.

Although the above report doesn't specifically state this, my cervical spinal cord is significantly compressed. The csf fluid is pushed away at the c5 and c6 spaces.

The neurologist who diagnosed me from the well respected clinic strongly recommended close monitoring. He found no true neurological deficit on exam but referred me to a neurosurgeon at the same clinic who said that the disks were large and "cause for concern" but did not recommend surgery "at this time". Of course, I was warned about the usual signs of an emergency such as weakness in the arms and/or legs; Tingling, numbness or pain in the arms and/or legs; Loss of bowel and/or bladder control.

I am very happy to report that none of these things have happened within the last year and I in no way expect them to find a neurological defict this year either.

The clinic who diagnosed me and whose advice I am trying to follow is several hours away from me. The neurologist there who diagnosed me realized without me saying anything about it that I did not know of my problems before coming to him and he was very uncomfortable with the fact that I had been getting the run around from my local doctors for four years and knew nothing of the existence or extent of my problems. To that end, he urged me to find a local neurologist to monitor me for early signs of myelopathy. In case you haven't guessed by now, my injuries result from 2 rear end collisions, one at a very high rate of speed and one by a very large commercial vehicle.

Since I live in a rural area, it is very hard to find good doctors. I found a neurologist in a neigboring town who is in the office a couple of days each week. From what I hear, she works for the insurance companies and runs around to neighboring counties doing emgs and stuff. This is the best I could find. Anyway, I have seen her twice within the last year.

The new local diagnosis which I will be informing the clinic doctors about are:

- Thoracic DDD with palpable muscle spasms and knots in the area of the annular tear which were found by the local neurologist 6 weeks ago and for which I have been taking 4 mg zanaflax twice a day with no relief of the significant mid to lower back pain or muscle spasms that are there daily and brought on by sitting.

- Mild left convex thoracic scoliosis (an incidental finding by a local radiologist who was reading a recent chest x-ray).

- Tronchoteric bursitus in left hip (for which I have received one injection that provided relief for about 3 months before wearing off.)

In addition to this, I attended a large county fair in September of this year at
which a couple of chiropractors were set up with scale like equipment that measures how straight you are.

One of the chiropractors at the fair did some measurements and handed me a paper with a diagram on it that shows that my left hip is 2 1/2 inches higher than my right hip, the left shoulder is 7/8" higher and the head curves downward to the left. The screening showed that I am putting 12 lbs more weight on my right leg as opposed to my left.

I got to thinking about this and remembered that I had seen a chiropractor 6 months after my first accident 5 years ago and he had done xrays of the entire spine. It was one of those deals where I saw an ad stating a full exam and x-rays were being offered for $40.00 so I made an appointment.

I picked up the 2002 x-rays from his office and brought them to both my gp and local neurologist. They contain pencil markings from the chiropractor which shows scoliosis throughout the spine. For some reason, however, I have a vague memory that he told me to put my right shoulder down before doing the x-rays. I never ended up treating with him as I was scared of chiropractors because of a previous bad experience with a different chiropractor not long after my first high speed accident in 2000.

I was referred to this first chiropractor by a local attorney. The attorney told me to tell the chiro that he had sent me. I was desperate for relief of my cervical burning pain and hip problems so I made the appointment and went to see him. I did not have x-rays or an mri with me at the time. I told this chiro that I would get a copy of the x-rays and would prefer to wait until he saw them, thinking this was safer.

On my 2nd visit to him a few days later, however, I still didn't have the x-rays as I had been told by his receptionist on the way out that he didn't really believe in them anyway. He convinced me to let him manipulate my spine anyway and proceeded to take his thumbs and put them on the back of my neck. He then applied very firm pressure and would not stop when I told him to. I will never forget the crazy and determined look in his eyes as he was doing this.

Shortly after this "adjustment" the radiating burning pain in my cervical area increased ten fold. All I could do was lay on the couch with an ice bag on it and cry. This is the only time I have cried about any of my many pain problems in 5 years. Needless to say, I never went back to him. I did talk to him on the phone a day or two later and asked what he had done to me. He couldn't tell me what this adjustment was called and didn't have a copy of his notes, so really didn't remember. The notes regarding my visits with him were "lost" for a long time, although I have recently obtained a copy of them.

I have posted to another board in which a neuro answers you and he has made the following suggestions regarding my upcoming appointment:

That I ask if the chronic cord compression is going to lead to myelomalacia (permanent damage) if not repaired.
That I ask if they think the pain in my mid to lower back is coming from the known disk with the annular tear (the local neurologist told me that she thinks it is).
That I see a registered physical therapist (I did so 5 years ago and it made things worse.)
That plain x-rays are the best way to check for scoliosis
If various diagnostic options would be appropriate for me
What interventions would be appropriate for my various spinal symptoms/problems.
That I choose a good neurologist who I trust to coordinate my care and to cut down on the confusion caused by seeing "a half dozen different doctors"

While I very much appreciate his reponse, I wanted to post here because I know many of you are well versed in all aspects of spine problems. If you have any suggestions or comments, please respond.

I only work part-time so it is his insurance that allows me to be seen at the well respected clinic. It is the only insurance I have. Needless to say, I have a big problem here.

I apologize for the lenth of this post. God Bless any of you who read it and respond to any part.





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