Spinal Cord Compression

[missy142]

Dr. Doc,

Any input appreciated.  Yes I am seeing orthosurgeons and Neurosurgeons.  Latest cervical MRI yesterday ordered by neurologist to r/o demyelinating disease.  Knew about the spine problems already but I think they've gotten worse.

Impression:
DDD, at C5/6 and C6/7 with spondylitic ridges/disc herniations at each level that result in compression of the left C6 and C7 nerve roots as well as mild spinal cord compression. at C5/6.  this MRI although on a 3T, was not as detailed due to the nature of request of clinical indcation being demyelinating disease.

No evidence of inflammatory demyelinating disorder.

On 3/8/09, my right foot went numb, left great toe pain, extreme lower lumbar pain radiating thru buttocks and down legs into feet.  Paresthesias in feet alternating, left anterior thigh, external genitalia area (both sides) and righ buttock, going on since like january.  On 3/9/09 woke up and couldnt walk, could hold myself up for only about 3 minutes due to severe muscle weakness.   Was too frightened to go to hospital, regret now.  Anway long story short, muscles weakness has relented over the period of the last 2 months.  a month ago I was using a cane.  Paresthesias in LE also relenting.  All symptoms in cervical area to be expected, pain in neck radiate scapula, radiculopathy bilateral into thumb and index fingers.  NEVER HAD upper extremity weakness that I was aware of .  bilateral numbess in hands.  2 cervical epidurals - improvement about 60%.  EMG/NCS of cervical confirmed radiculopathy and mild bilateral carpal tunnel.

QUESTION:  Why wont my md's concede this is from my injury in the cervcial area.  They are trying to r/o other things as they are trying to say that my cervical area was not causing extreme leg weakness etc.

Next appt with new neuro next wednesday (been there once, seems like a good guy) with upated cervical spine on 3T MRI.  Also have T7/8 herniation pressing on thecal sac, multiple higher up thoracic buldges pressing on thecal sac as well, also unfortunately done on .6T stand up MRI.  Brain MRI done on 3T - several scatter punctate r/t migraines, what else can they say.  

I would like to redo my throacic on a 3T trying to arrange with insurance to r/o lesions and further clarify herniations.

Isnt it possible I have cervical spondylotic Myelopathy and this is the problem with lower extremeites?  
Also with cord compression do you think I will need surgery and will this progress.  I know this is speculation obviously.

thankyou for your opinion
missy

[abhijeet v ghosh]

hi missy,
the profession is not helping your problem. Since you are a nurse, you will understand clearly. No matter how severe the stenosis is on MRI, we treat the symptoms. You know that. Can you change you job profile a little?
regarding being wrong or right, medical science is all about exceptions. So what all doctor's judge depends on the interpretation as well as physical findings. I , being not able to examine you, won't be able to give you a 100% diagnosis. But i can give you my opinion only. Your doctor, will be your best judge presently. Just trust him and hopefully all will be perfect.
regards

[missy142]

I wrote back to you:)

[missy142]

thanks for answering yes I had a lumbar MRI, herniation at L5/S1, no impingement on nerves or cauda equina.  I was misdiagonsed with cauda equina syndrome by my first surgeon who said I had the beginnings of it, when I got 2 other opinions the md's said "Its not even pressing on anything, it cant be cuada equina syndrome".  It also proceeded to improve as I said over the following 2 months.

So my second ortho ordered a brain MRI and a thoracic MRI which ive given you the results. (These were done to r/o demyelinating disease. and to see if there were any more herniations in my thoracic area, which there are, I told you that T7/8 pressing on thecal sac with multiple upper thoracic buldges pressing on sac as well.

I am 47 yr old female.  Im a  nurse.  I was working at a desk as a nurse case manager working on computer and talking to patients, and their doctors all day. I never even knew I had any of this until prolonged sitting started the whole ball rolling.  I had one car accident when i was 20 where i hit the steering wheel with my neck and concussion.

Well surgery has always been on the table for my neck, but I havent decided that so far.  I had 2 epidurals in cevical area which i stated helped a great deal although I still have some intermittent radiculopathy and upper back pain left side (around scapula).  Im having a triggger point injection there next week to relax that muscle.

Anyway my neurosurgeon has not seen my new cervcial MRI as I said which was done on a 3T machine as opposed to the first one that was done on a .6T (6 months ago) which showed Ventral cord abutment and IMpression but didnt say compression.  Also cervical STENOSIS AND FORAMINAL NARROWING.

Any more thoughts?

I am sure that this is from my neck there is nothing else wrong with me.  I was tested for lymes last year (western blot) negative, there have been no lesions thus far.
NO LP has been done or bloodwork yet as I had an A-hole for a neurologist who called me stupid 4x because I didnt go to the hospital when this happened.

Anyway off to the neurosurgeon on wednesday.  But I think you are all wrong,  I have read so many articles about people with cervicle herniations mild cord compresssion or not that have Lower extremity syptoms.

Thanks so much for your time, Any more thoughts?
missy

[abhijeet v ghosh]

hi missy,
how are you. So you see your question was not left.

i need to know how old are you, your profession, any significant medical history? Myelopathy  can be a problem acc to the MRI. but it's only a mild spinal cord compression. But it's unlikely that this is causing any lower extremity problem. I am surprised why your thoracic spine MRI was done. They should had ordered lumbar spine MRI for the lower extremity problem.
Can you tell me what treatment they have advised you presently?
regards