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Spinal Cord Disorders Message Board


Spinal Cord Disorders Board Index


Hello all-

I have been seeing about a billion different docs over the past 6 months (it sure feels that way, anyway! :) for what started out, I thought, as some innocuous tingling in my hands. 2 months in wrist braces and an EMG later, they started questioning if it was my neck and not my wrists or elbows. They finally ordered an MRI last month and this is what they found:

MRI CERVICAL SPINE W/O CONTRAST
INDICATION
A 33-year-old female with neck pain and bilateral hand numbness.
TECHNIQUE
Sagittal T1, T2, inversion recovery, and axial 3D and gradient-echo
T2*, and T1 MR images of the cervical spine. No comparison.
FINDINGS
Cervical alignment and marrow signal are normal. There is cervical
cord abutment and increased T2 signal within the cord from C3
through C5 compatible with cervical myelomalacia secondary to disk
degeneration and ventral abutment as detailed below.
Craniocervical junctional anatomy is unremarkable as is C2-3.
C3-4 has moderate central canal stenosis with a mild posterior disk
bulge abutting and flattening the ventral aspect of the cervical
cord. Uncovertebral spurring encroaches the neural foramina.
C4-5 has moderate posterior osteophyte-disk complex and mild
uncovertebral spurring with ventral abutment, and flattening of the
cervical cord, and moderate central canal stenosis. Neural foramina
are mildly encroached.
C5-6 has mild uncovertebral spurring and mild posterior disk bulge
causing mild central canal stenosis. No cord abutment or
compression.
C6-7 and C7-T1 levels are unremarkable.
Paraspinal soft tissues and musculature are unremarkable.
Visualized posterior fossa is unremarkable. Cerebellar tonsils are
normal in position.
IMPRESSION
Moderate C3-4, C4-5 and to a lesser extent C5-6 degenerative disk
disease. Mild to moderate posterior osteophyte-disk complex and
disk bulging cause moderate central canal stenoses, primarily at C3-
4 and C4-5, with signs of cervical myelomalacia.
I suspect there is underlying degree of short pedicles and
congenital narrowing of the central canal.

I have had years of neck pain following a whiplash injury to my neck - most of the time, the pain is not unbearale, though i do always have some degree of limited range of motion, but about once a month i have an episode that lasts for 7 or 8 days where i can't move my neck or sleep. My dr had been prescribing me 5mg flexeril tabs 1x per day and 800 mg ibuprofen, neither of which did much for the pain. I also get pain that radiates down both my arms, along with periodic severe pain in my hips and low back (where they discovered a herniated disc) and pins and needles in my legs and feet - because of all this pain, I was slapped with a fibromyalgia diagnosis years ago and everyone has ignored me when I said I had pain until now. I saw my orthopedic surgeon after the MRI and he said I had a lot of damage but that it could be vitamin deficiency or thyroid issues causing the pins and needles and sent me for a neurology consult.

So today I saw the neurologist and he said my symptoms were certainly from my neck and that I definitely need surgery soon and that with the bruise on my spinal cord if I were to sustain a whiplash injury now I would likely be completely paralyzed - he also said that the discs in my neck in combination with the congenital stenosis is actively da,aging my spinal cord and if I don't have surgery I could wake up and be partially or fully paralyzed at some point, just from living.

I am trying to get my GP to make a referral to a neurosurgeon but she seems to be dragging her feet. This is all happening very quickly for me so I am looking for some advice/support from people who have been there before.

Thanks.

Jessica
kitti - thanks. I did end up getting in to see a second opinion - they want to do ACDF C3-C4 and C4-C5 - she doesn't want to do the C5-C6 level because of my age. I am finding it all very overwhelming to think about having neck surgery as I have a young child, can't get a job until I have recovered, and I guess just because it is a scary thing. I guess I am more afraid of having an accident and becoming paralyzed though - I am an avid equestrian and have been given a strict no riding from the neurosurgeon until after surgery, at which point she feels I will be ok to get back on.

Anyway, I guess I am just getting frustrated that after 2 neuro consults my GP is still acting like this is no big deal even tough they now say I need surgery =/
Wanted to post an update since I now have 4 opinions and am really more on the fence about surgery than ever.

So the first neurologist said my symptoms were certainly from my neck and that I definitely need surgery soon and that with the bruise on my spinal cord if I were to sustain a whiplash injury now I would likely be completely paralyzed - he also said that the discs in my neck in combination with the congenital stenosis is actively da,aging my spinal cord and if I don't have surgery I could wake up and be partially or fully paralyzed at some point, just from living. He had previously done an EMG on both arms to check for carpal tunnel that were all normal. I am not sure what the results of his neuro exam were, as they were done before the stenosis thing was even a blip on my radar, and I still believed that my parasthesias were caused by carpal tunnel, but I know he didn't do any hoffman's tests or Romberg test - I can't even remember if he did the normal strength/reflex tests.

The first neurosurgeon said that she wanted to surgery sooner rather than later - they found left tricep weakness, left positive hoffmans, 3+ reflexes in arms and legs, very positive Romberg test. She gave me a window of "a few" months to have surgery, and said it wasn't an emergency but should be done. Nor horseback riding until after surgery. She offered me a 2 level ACDF for C3-C4 and C4-C5.

The Orthopedic spine surgeon said I needed surgery at some point and that there wasn't any point in putting it off, though it wasn't an emergency. He did not do a neurological test as he is the one who sent me to the first neurologist. He offered me a laminectomy from C3-C6.

Third Neurosurgeon (and the one who my GP apparently trusts the most) had a PA come in to do my neuro exam - she found nothing abnormal except brisk reflexes in both legs and my right elbow. She did not do a Romberg test. I noticed a couple of times that my strength seemed remarkably different from my left to my right, she did not seem to. The Neurosurgeon himself said that he felt that I was a surgical candidate. However, he also said that what I needed to do was to pick a disability level that I was not comfortable with keeping forever and then have surgery before that time, otherwise it was up to me when to have it. He said it's possible, though unlikely, that my symptoms won't get any worse. He said that either the ACDF (which he also suggested a 2 level saying that it would likely be anther 10-15 years before I needed another surgery for C5-C6 and they might have something better to offer me then) or the laminoplasty/laminectomy solution would be fine, though he would lean 55/45 in favor of the ACDF despite my congenital stenosis because I have loss of loridosis as well, but that I would probably have to get other docs involved if I had ACDF as I have severe vit D deficiency that is not responding to oral treatment which might make me more likely to have failure to fuse. He also said they would do a 2 level artificial disc and that they could try to get insurance to pay for it, but that we would have quite a fight to make it happen, if they would go for it at all. He also said he felt the risk of paralysis from injury was small and to keep riding my horse because it makes me happy.

So, after this last doctor, I am left wondering if I need surgery at all, really, but also thought it was really strange that the PA didn't find any of the abnormalities that other docs have found. Before I saw the first neurologist, I was seeing a pain doc for my herniated lumbar disc - I had mentioned to her that the ortho spine doc thought it might be my neck and not carpal tunnel, she did a bunch of reflex testing and said I had a positive Hoffman's and brisk reflexes on my arms and legs (3+) I wonder if this made him more relaxed about the surgery option.

I just don't know what to do - anyone have any insights that might help me make this decision? I can't tell if I am in denial of the severity of the issue or overinflating it.





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