Connect
← Return to Recommendation for a neurologist to evaluate me for spinal stenosis.
Discussion
Recommendation for a neurologist to evaluate me for spinal stenosis.
Spine Health | Last Active: Feb 22, 2023 | Replies (16)Comment receiving replies
Hi Jennifer, this is the cervical MRI report
Cervical Spine…conclusion of report….
Disc bulging with osteophytes complex causes moderate compression of
ventral thecal sac and mild ventral cord flattening at C3-C4, C4-05,
end C5-C6. The most affected level is C5-C6, with the neural canal
measures 8.1 mm in maximum AP dimension.
2. Osteophytes cause bilateral foraminal encroachment at C4-05 and
C5-C6. Osteophytes cause mild left-sided foraminal encroachment at
C6-C7 and C3-C4.
The good news is there were no signal changes in the cord in 2018 to indicate myelomalacia.
Just to address symptoms :
Numbness both upper extremities is related to neck positioning
Weakness in both upper extremities
Increasing loss of dexterity in hands
Mild tremor in hands
Occasional loss of balance
Nocturnal leg muscle cramps
Doug Cosentino
Replies to "Hi Jennifer, this is the cervical MRI report Cervical Spine…conclusion of report…. Disc bulging with osteophytes..."
@dgcosentino831
Doug,
I had another thought of what may help you right now while you are waiting for an exam. I was working with a physical therapist when my spine problem started becoming evident, and I continued this therapy and also did myofascial release. She was trained in the John Barnes methods, and did a lot of this on my neck because of thoracic outlet syndrome. She was also using a Dolphin Neurostim unit on the cervical nerve roots. There is a setting that interrupts the neuro transmitter pain signals, and I found that it reduced my pain for about a week at a time. That was during the time when I was having trouble finding a surgeon to help me, and my symptoms were getting worse.
Myofascial release helped a lot to loosen my neck, so it was easier for the surgeon to retract during surgery. During my consult, his comment about my neck skin was "loosey goosey" when I asked what I could do to make his job easier. This set me up for a successful surgical procedure, and after surgery and healing, MFR helped loosen the scar tissue which reduces pain. If you need to find a PT trained in these methods, there is a search at http://mfrtherapists.com/
Here is our MFR discussion: (the first pages have lots of links to information)
Myofascial Release Therapy (MFR) for treating compression and pain: https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Dolphin Neuro Stim https://www.dolphinmps.com/
This helped me buy some time before I could have decompression surgery. It doesn't fix anything, but may help you feel better at least temporarily.
Jennifer
Connect
@dgcosentino831
Doug, thank you for your report. My imaging of my C spine did not show myelomalacia, and my Mayo surgeon, Jeremy Fogelson, told me that myelopathy does not always show up on an MRI, but can be present. My MRI showed no damage to the spinal cord, but I was getting muscle atrophy on the back of my shoulders and in the triceps. The short answer is that every symptom you listed can be associated with cervical spine issues. I actually had vertigo a few times because muscle spasms were causing independent rotating or tilting of my upper vertebrae and when that happened to C1 & C2 it caused extreme dizziness that could come on suddenly. Rotation of the C vertebrae stretches the vertebral arteries affecting flood flow to the brain much like what happens with Bow Hunter's syndrome. It also caused occipital headaches usually on one side, jaw misalignment, ear pain or a choking sensation.
Are your symptoms a new development that didn't occur in 2018? Generally speaking, surgery should be done before permanent damage happens, and not all patients feel pain from cervical cord compression and are surprised to find out they are at risk of paralysis if they were in an accident in their current condition. When myelomalacia shows up on an MRI as a white mottled appearance inside the spinal cord, it represents nerve axons that have died and dissolved in the spinal fluid. I said that here because many other patients don't understand what that means.
I agree that you need to see a specialist and there may be a long wait. What I have found is that many spine surgeons want you to see the neurologist that they prefer to work with so it makes sense to seek a consult with a spine surgeon. Dr. Fogelson sent me to neurologist, Dr. Bartleson, in the spine center at Rochester for testing and a full exam. The neurologist didn't say that I needed surgery based on his findings, but the neurosurgeon did recommend surgery. Your report and symptoms do match up to what a doctor might expect.
Here are a couple links, a Mayo podcast that defines stenosis measurements and treatment options. It is for patients, but covers a lot of useful information.
and a video presentation about surgery for cervical stenosis from a spine surgery conference
https://www.youtube.com/watch?v=8cW6ANDJah8
My surgery was a C5/C6 fusion with donor bone spacer and no hardware. I stayed in a neck brace for about 3 months until it fused. The surgeon offered this because it was a single level, and may not have done that if it was more than one. I had concerns about immune responses to metals because of reactions to pierced earrings in my past and having no hardware let me avoid any possible complications with that. If you have surgery, there would likely be hardware. It is a long recovery and the first 6 weeks were the most painful, but that is different for everyone. This is my patient story:
https://newsnetwork.mayoclinic.org/discussion/using-the-art-of-medicine-to-overcome-fear-of-surgery/
Also you need a better surgeon because of the C3 involvement. Many spine surgeons do not want to operate on levels that close to the skull, and because the Phrenic nerve that partially innervates the lungs for breathing emerges near there from the spinal cord. Fusions of these levels will limit movement. My C5/C6 fusion does not limit my head turning. That is mostly done by C1 & C2 with some help from C3 & C4. I also have thoracic outlet syndrome that causes compression on nerve and vessels between the collar bone and rib cage and near points where it passes through the heads of the scalene muscles and under pec minor near the armpit.
I will send you some information by private message. If you have more questions, please ask. In the links I have sent, doctors say that loss of balance is considered a serious issue when it comes from spinal stenosis, and with aging that can get worse. My elderly mom has no balance and spends her days in a wheelchair. The stenosis measurement of 8.1 mm is significant. That is discussed in the Mayo podcast video link. I hope this has been helpful.
Take care,
Jennifer