Double Vision & Spinal Stenosis

@ dablues I also responded on your other post. This report indicates some multilevel issues, and loss of disc height at C5/C6 which is putting pressure on the facet joints and at that level they are causing arthritis and affecting the nerve roots causing foraminal stenosis or compression of nerve roots that exit the spine. The vertebrae get closer together when a disc looses height, and if there is already compression at the nerve roots, movements like twisting or side bending the neck might make that worse. I did not have arthritis around my nerve roots, and my disc lost 50 % of it's height. If I did side bending, it did put pressure on the nerve roots and send pain down my arm where it did not happen if I was straight. My MRI report described mild canal stenosis with a minimal indent of the spinal cord and it described neural foraminal narrowing on one side. That wasn't true. My surgeon told me the foramen was clear, and he didn't need to clean anything out of there during my surgery. You do have some backward slipping of C5 over C6 which I also had and your report states changes of the end plates at C5/C6. It mentions modic changes. I looked that up and it might indicate inflammation that can come from the inner disc material that gets extruded with a herniated disc, or from small cracks in the vertebrae that affect the bone. I also had what was considered mild spinal canal stenosis at C5/C6 and I had a lot of pain and symptoms. I lost about half of my muscle mass in my arms and shoulders. What can happen if no surgery is done for a collapsed disc and arthritic changes, is that the bones of the vertebrae can fuse themselves and that may not be in a good alignment, and you would still have the compression of the nerve roots. Make sure to ask your specialists what will happen if your spine condition is allowed to progress on it's own with no intervention.

You may want to see a spine specialist, and start looking now for a surgeon of your choosing. You'll probably need to wait for that appointment as you go through your other scheduled tests and I have heard of waiting 3 months to see a good surgeon for a first appointment, then waiting again to get on his surgical schedule could be a month or 2 or 3.... You don't need to wait to complete your current testing appointments and followup before scheduling to see a surgeon and likely it will be finished before an evaluation, and you'll feel more in control of things if the decision of which specialist is not left to chance. You can ask your primary care doctor for a recommendation, and it is good to get second opinions before you decide on surgery as there might be different recommendations offered, and you need to be completely confident with the surgeon you choose. I hope I'm not overwhelming you with information. For me, I need to understand in detail why and how it all works. Here are some links that explain the imaging. You may want to compare your imaging to what you see here.

https://healthcareextreme.com/how-to-read-your-spine-mri-study/
This video (about an hour) explains a lot about cervical spine problems and treatments and shows and explains MRI images.
https://www.youtube.com/watch?v=xFPk4efcJ1g

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Maybe my first post was wrong but here are the findings on the MRI Cervical [without contrast]. So not sure if this would be related to double vision or if something else is going on in my brain. Input would be appreciated. Study MRI Cervical [without contrast] 72141
Clinical History: Paresthesia, dysesthesia, behavioral change. Burning sensation in neck radiating to back of legs.
Comparison: 06.08.12
Findings: There is minimal chronic retrolisthesis of C5 on C6. Alignment of the cervical spine is otherwise within normal limits. Modic type 1 endplate changes noted at C5-C6. Otherwise there is no abnormal marrow edema in the cervical vertebrae. The prevertebral soft tissues are normal. The visualized posterior fossa contents are unremarkable. The cervical cord demonstrates normal caliber and signal.
C2-C3: Chronic calcification within the C2-C3 disc space. No significant disc herniation. No spinal canal stenosis. No significant neural foraminal stenosis.
C3-C4: Mild posterior disc osteophyte complex, eccentric to the left. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in severe left neural foraminal stenosis.
C-4-C5: Mild posterior disc osteophyte complex. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in severe left neural foraminal stenosis.
C5-C6: Mild posterior disc osteophyte complex. Mild degenerative disc space narrowing. Prominent anterior vertebral osteophyte formation. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in moderate bilateral neural foraminal stenosis.
C6-C7: Minimal posterior disc osteophyte complex. No spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in mild left-sided neural foraminal stenosis.
C7-T1: No significant disc herniation. No spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in moderate left and mild right-sided neural foraminal stenosis.
T-1-T-2, T2-T3, and T3—T4 are visualized on the sagittal sequences only and demonstrate no significant disc herniation.
Impression: Multilevel degenerative disease as detailed above. Mild spinal canal stenosis at C3-C4, C4-C5, C5-C6. Multilevel neural foraminal stenosis.

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@dablues You do have a significant amount of multilevel cervical issues causing spine related symptoms. You might also want to consider a neuro-opthalmologist because of the double vision. Here is a link that explains some of the things that neuro-opthalmologists address. It has an overlap with neuro-surgery. According to this Mayo article, there are few of these specialists, but Mayo has them on staff. I think it would be to your advantage to work with an interdisciplinary team that can address all the issues. It sounds like your current specialists don't know what is causing the double vision, and that can be a source of uncertainty for your doctors. I hope this is of value.

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Maybe my first post was wrong but here are the findings on the MRI Cervical [without contrast]. So not sure if this would be related to double vision or if something else is going on in my brain. Input would be appreciated. Study MRI Cervical [without contrast] 72141
Clinical History: Paresthesia, dysesthesia, behavioral change. Burning sensation in neck radiating to back of legs.
Comparison: 06.08.12
Findings: There is minimal chronic retrolisthesis of C5 on C6. Alignment of the cervical spine is otherwise within normal limits. Modic type 1 endplate changes noted at C5-C6. Otherwise there is no abnormal marrow edema in the cervical vertebrae. The prevertebral soft tissues are normal. The visualized posterior fossa contents are unremarkable. The cervical cord demonstrates normal caliber and signal.
C2-C3: Chronic calcification within the C2-C3 disc space. No significant disc herniation. No spinal canal stenosis. No significant neural foraminal stenosis.
C3-C4: Mild posterior disc osteophyte complex, eccentric to the left. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in severe left neural foraminal stenosis.
C-4-C5: Mild posterior disc osteophyte complex. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in severe left neural foraminal stenosis.
C5-C6: Mild posterior disc osteophyte complex. Mild degenerative disc space narrowing. Prominent anterior vertebral osteophyte formation. Mild spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in moderate bilateral neural foraminal stenosis.
C6-C7: Minimal posterior disc osteophyte complex. No spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in mild left-sided neural foraminal stenosis.
C7-T1: No significant disc herniation. No spinal canal stenosis. Uncovertebral spurring and facet arthropathy result in moderate left and mild right-sided neural foraminal stenosis.
T-1-T-2, T2-T3, and T3—T4 are visualized on the sagittal sequences only and demonstrate no significant disc herniation.
Impression: Multilevel degenerative disease as detailed above. Mild spinal canal stenosis at C3-C4, C4-C5, C5-C6. Multilevel neural foraminal stenosis.

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@dablues I had my checkup with my opthalmologist yesterday, and I asked him if a cervical spine problem can cause double vision. His answer was yes, and that there can be a lot of different causes for double vision. He said to look up "Convergence insufficiency" which means that the eyes don't converge well and can see independently causing double vision or "Diploplia" instead of our normal binocular vision. I've been looking for literature about this and I found this which may interest you. Here is the link and a quoted paragraph from the publication from the Results discussion at the end of the literature.

"A cervical problem can cause an alteration of binocular vision

Three reflexes influence head, eye and postural stability [47], which depend on cervical afferents: the cervico-colic reflex (CCR), the cervico-ocular reflex (COR) and the tonic neck reflex (TNR). These reflexes carry out their functions together with others, being influenced by vestibular and visual input for coordinated stability of the head, eyes and posture. The COR works with the vestibular-ocular reflex (VOR) and the optokinetic reflex (OKR), acting on the extraocular muscles, to maintain stable vision in the retina during head movement. This reflex responds to proprioceptive signals that come from the deep muscles of the neck and the joint capsules from C1 to C3 to reach the vestibular nuclei [48]. A greater gain in COR has been demonstrated in whiplash patients [48]. In this context, an altered cervico-ocular reflex in subjects with neck pain could modify the tone of the extraocular muscles, leading to the destabilization of a phoria by altering the range fusional vergences and thus appearing a binocular alteration."

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@dablues I had my checkup with my opthalmologist yesterday, and I asked him if a cervical spine problem can cause double vision. His answer was yes, and that there can be a lot of different causes for double vision. He said to look up "Convergence insufficiency" which means that the eyes don't converge well and can see independently causing double vision or "Diploplia" instead of our normal binocular vision. I've been looking for literature about this and I found this which may interest you. Here is the link and a quoted paragraph from the publication from the Results discussion at the end of the literature.

"A cervical problem can cause an alteration of binocular vision

Three reflexes influence head, eye and postural stability [47], which depend on cervical afferents: the cervico-colic reflex (CCR), the cervico-ocular reflex (COR) and the tonic neck reflex (TNR). These reflexes carry out their functions together with others, being influenced by vestibular and visual input for coordinated stability of the head, eyes and posture. The COR works with the vestibular-ocular reflex (VOR) and the optokinetic reflex (OKR), acting on the extraocular muscles, to maintain stable vision in the retina during head movement. This reflex responds to proprioceptive signals that come from the deep muscles of the neck and the joint capsules from C1 to C3 to reach the vestibular nuclei [48]. A greater gain in COR has been demonstrated in whiplash patients [48]. In this context, an altered cervico-ocular reflex in subjects with neck pain could modify the tone of the extraocular muscles, leading to the destabilization of a phoria by altering the range fusional vergences and thus appearing a binocular alteration."

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@jenniferhunter

I have an appointment with my ophthalmologist on the 6th of February to talk once again about my diplopia. I'm told that there could be autonomic neuropathy involvement, but it's very difficult to get any kind of commitment to a certain diagnosis.

I've noticed that one eye sees, on its own, images to the right of where the other eye does.

Night driving is challenging because I see the two headlights with a second set above or below. And standing on the deck at night, I look at the lights of town, 7 miles away, and there is a perfect double set. It's hard to know which one is the actual light or the secondary one. Rather frustrating and disconcerting disorienting. I'm hoping the doctor will have something that explains the diplopia, and even more, a way to correct it.

Jim

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@jimhd My eyes don't converge perfectly either, but that is only an issue at very close ranges for me. Each eye sees a different angle of the view because of the distance between your eyes, and you can see the difference by covering each eye independently and comparing. The brain puts these two different visual images together in the visual cortex to create 3 dimensional vision with depth perception. The movement of each eye ball is controlled by several small strap like muscles attached to it that move it different directions and serviced mainly by the occulomotor nerve. If there is a problem with the nerve and it doesn't communicate correctly with the muscles, that affects the ability to physically move the eye correctly. That's a simple explanation of how it works. I hope your opthalmologist can find a resolution for you. I used to wear contacts where one eye was corrected for distance and the other for close vision. I'm nearsighted. What I found was that the distance eye became the dominant one and I wouldn't see the image from the close eye unless I focused on something closer. I don't know if that would work now because my eyes have changed as I've gotten older, and I am less near sighted now.

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