Auto accident cervical - pinched nerve and spinal cord herniation
I am looking for a Neurosurgeon. I was in a vehicle accident 8/2024. MRIs show herniations at C3-C4, C4-C5, C6-C7, Nerve Root Compression (Radiculopathy), and Spinal Cord Compression (Myelopathy), abnormal neck curvature (kyphosis) and vertebral slip (retrolisthesis), foraminal stenosis (narrowing of the nerve exits) at C3-C4, C4-C5, and most significantly C5-C6, and 3 small lumbar herniations. I had X-ray guided steroid injections in my cervical and lumbar. Lumbar didn't help, so we did a nerve block. 10/2024 I had my left carpal and left thumb ligament reattachment surgeries. 4/2025 I had right carpal surgery. I was on pregabalin and meloxicam 12 months and also steroids by my Pain management doctor. I don't like taking pain medication so I take intermittently. I have tingling in my fingers, trouble carrying anything over 7 lbs, drop things, my hot/cold sensations don't work properly, my balance is slightly off. I'm looking for someone to explain my MRI in lame-mans terms. I'm 45 trying to decide which route to go picking a Doctor.
PROCEDURE: MRI CERVICAL SPINE WITHOUT CONTRAST
TECHNIQUE: Multisequence, multiplanar MRI obtained on a high-field 1.5 T MRI
system
CLINICAL INDICATION: Neck and back pain, thumb/wrist pain; history of motor
vehicle collision 8/2/2024
COMPARISON: No prior studies available for comparison
FINDINGS:
There is abnormal reversal of the lordotic curvature which may be seen in
conjunction with posttraumatic myospasm, articular dysfunction or other
biomechanical abnormality. In addition, it has been suggested that cervical
kyphosis may be associated with abnormal increased load on the spinal cord
and/or nerve roots. Advise clinical and radiographic correlation.
C2-C3: Disc height is adequate. Posterior elements are normal. No evidence of
focal herniation. No significant stenosis or neural mass effect observed at
this time.
C3-C4: Dorsal, left asymmetric 1-1.5 mm herniation. Adequate disc height.
Facet joints are normal. No significant stenosis or spinal cord or nerve root
compromise.
C4-C5: Right paramedian herniation measuring approximately 2 mm. Normal
posterior elements. Disc height is adequate. No foraminal stenosis exiting
nerve root compromise. There is encroachment of the right anterolateral spinal
cord margin without spinal cord compression.
C5-C6: Disc height narrowing with 3-4 mm broad-based uncinate
proliferative-herniation complex observed. Grade 1 retrolisthesis of C5. There
is posterior element hypertrophy. Combined changes creating ventral spinal
cord abutment and low-grade compression asymmetric to the left. Neural
foraminal stenosis observed. Clinical correlation for posttraumatic C6
radicular involvement or myelopathy recommended.
C6-C7: Disc height is adequate. Posterior elements are normal. No evidence of
focal herniation. No significant stenosis or neural mass effect observed at
this time.
C7-T1: Disc height is adequate. Posterior elements are normal. No evidence of
focal herniation. No significant stenosis or neural mass effect observed at
this time.
No compression fracture. Marrow signal alteration demonstrating hyperintensity
on fluid sensitive images and low signal on T1 seen at the opposing C5-C6
vertebral margins thought to represent Modic type I reactive inflammatory
changes; however, given the patient's history of recent injury posttraumatic
contusion could be considered as well. No aggressive vertebral or marrow
lesion identified.
There is no evidence of intramedullary or intradural masses or signal
alteration. The spinal cord is of normal caliber. Atlantoaxial level is normal
in appearance and the craniocervical junction is unremarkable without evidence
of cerebellar tonsil herniation. No specific abnormality of the paraspinal
musculature. Normal vascular flow voids are noted. The remaining
paravertebral soft tissues are normal in appearance to the extent visualized.
CONCLUSIONS:
1. Segmental changes involving the discovertebral junctions and/or posterior
elements as detailed in the level-by-level analysis above.
2. C5-C6 neural encroachment-compromise as discussed. Please see above for
more detailed segment specific descriptions. Recommend clinical correlation
for associated posttraumatic radicular involvement and/or myelopathy as above.
3. Abnormal cervical kyphosis as discussed in the opening paragraph above.
Clinical and radiographic correlation advised for posttraumatic myospasm,
articular dysfunction and/or other abnormal spinal biomechanics.
4. The retrolistheses at C5-C6 suggest possible underlying injury and/or an
impairment of the anterior longitudinal ligament at this level. No acute edema
or full-thickness ligament tear is visible on this exam.
5. C5-C6 type I Modic changes versus posttraumatic contusion as discussed
above.
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@laurenmolee Lauren, welcome. I’m sorry you are dealing with an injury that seems to be a whiplash. Typical injuries from whiplash affect C5/C6 which is what happened to me. You have lost some height in this disc and have backwards slipping which I also had. I didn’t have any therapy early on and my condition worsened with aging. 19 years later, I had spinal cord compression and the disc had collapsed by 50%. I had spine surgery at Mayo with Dr. Jeremy Fogelson and had a bone disc fusion without hardware.
I also have thoracic outlet syndrome which causes compression of nerves and vessels going to the arms. A whiplash can cause TOS and it can cause overlapping symptoms making it difficult to determine where the source of pain originates. It could be the spine or anywhere else along the path of the nerve that cause the same symptoms. If you are able to go to Mayo, they can evaluate you for TOS in their vascular lab. Usually treating TOS is with physical therapy. There can also be pain from the spine injury so there can be multiple places causing pain.
As time goes on, the inflammation and uneven pressure can cause bone spurs to grow alongside herniated discs. That happened to me too. My disc osteophyte complex was pressing 5 mm into my spinal cord. That wasn’t causing serious damage yet, but it had the beginning of big pain symptoms. Having surgery at this stage prevented further damage to my spinal cord.
You have more levels of injury described by your imaging, and still have good disc height. When discs collapse, more weight is shifted to the facet joints (that allow twisting) and it causes wear and tear there. Facets bear about 20% of body weight with the rest born by the discs.
If you are able to go to Mayo and your insurance is accepted there, it would be a great place to go. I highly recommend Dr. Fogelson. If you need surgery, it may not be everything at once. You might have monitoring and ongoing PT. Dr. Fogelson is at the Rochester campus. He is an excellent surgeon and I had a wonderful recovery.