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NCS Results - Bad from just June!!

Aviatrix36440Aviatrix36440 Posts: 5,904
edited 06/11/2012 - 8:43 AM in Neck Pain: Cervical
Howdy all, my turn to ask for "opinions" on what I am going to post - and yes I know none of us are doctors. :-) On the 8th of April I had a bad run in with a Neurologist who had a fit when he found I was allergic to Latex, and wouldn't get Nitrile gloves or accept the ones I keep with me for such occasions. Please see post number 36 at for the whole deal:

My neck is a mess, but it has seemed manageable to the point I am/was thinking my back issues could be addressed now. I am beginning to wonder now after my last NCS (NCV).

In June 2009 before my fusion for C6/7 my results were: (these two tests were taken by the way at the same doctors office, and by the same person) - I am just listing the NCS not the EMG as I am now scheduled in 2 weeks for a upper extremity and upper spine EMG due to these results...

June 19, 2009

"Evaluation of the Right Ulnar Anti Sensory nerve showed prolonged distal peak latency, reduced amplitude, decreased conduction velocity (Wrist-5th Digit) and decreased conduction velocity (A Elbow-B Elbow). The Right Median Motor nerve was unremarkable. The Right Ulnar Motor nerve was unremarkable. The Right Median Anti Sensory Nerve was unremarkable.

IMPRESSIONS: The above electro-diagnostic study reveals evidence of moderate chronic C6 and C7 radiculopathy on the right. Mild right ulnar sensory neuropathy below the elbow."

Now this one - again NCS/NVC only...

"Evaluation of the Right Median Motor nerve showed reduced amplitude. The Right Median Anti Sensory nerve showed no response (Elbow), no response (Axilla), no response (Erbs), prolonged distal peak latency, reduced amplitude, and decreased conduction velocity (Wrist-2nd Digit). The Right Median Acr Palm Anti Sensory nerve showed prolonged distal peak latency (Palm).

IMPRESSIONS: The above electro-diagnostic study reveals evidence of a moderate right carpal tunnel syndrome (median nerve entrapment at wrist) affecting sensory and motor components."

Okay, now I did a bit of research, and am trying to figure out (and the graphs show pretty much what he listed for "lack of activity" in the nerve areas), how in the world would he only come up with Carpal Tunnel when there is obviously problems up beyond the shoulder? The Axilla and the Erbs involve relation to the C5/6/7 - the Ulnar, C7/T1 (C8 nerve root). I also had a full physical assessment from top to bottom the other day, and the "feeling" of the doctor is my C7/T1 is going, and there are impingement issues within my present fusion areas.

The doctor that gave the "IMPRESSIONS" by the way, is the one I refer to in my post referenced above. His findings don't seem to match the machine? I am therefore asking you my fellow spineys (that I know aren't doctors, and will take such insight as such) what you all think. From the numbness from my hand to my armpit, and related pain and zings ...I think a lot is going on, and this is not going to be a good year! Thanks in advance guys!!!


PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.


  • MetalneckMetalneck Island of Misfit toysPosts: 1,364

    A couple of suggestions from experience. Many physicians don't even consider EMG's or NCV's to be "really good" diagnostic tools. I would ask (or insist) for a yet another MRI or Cat scan to get a better idea of the (new) pathology that is most likely present.

    I would also consider taking your case to a different neurosurgeon or (IMHO) an orthopedic surgeon. Surgeons don't easily admit that all their best efforts failed (or were not aggressive enough) the first time around.

    In my case I had a 3 level fusion that failed to fuse and quickly lead to herniation of an adjacent disk. After over a year of paining and complaining I found an ortho who basically said "we'll have to redo the whole shabang++. That brought me to my current status of four level anterior - 2 vertebrectomies - cage - and posterior rods.

    Guess what ... I have now have progressive numbness - weakness - increasing pain - etc. etc. etc. I guess thats why its called degenerative disc disease. In my and I believe a disturbing number of us, our problems are progressive.

    I hope that you can find the relief that you need and deserve ... I will keep you in my thoughts and prayers.

    Spine-health Moderator
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  • Howdy Metalneck,

    I agree with much of what you said. Actually *my* present Neurosurgeon sent me for the EMG/NCS and consult with another Neurosurgeon. :-) My surgeon is really good, and doesn't seem to have any issues that something might be going on within the fusion area he worked on. Odd huh? So in short, he is not pushing me off at all.

    He is also the one who set me up with a new Neurologist after the "issue" with the one down here where I live. So I feel that I am still a good fit with my original surgeon as he has been getting me with the right folks for the diagnostic testing to see what the heck is going on.

    Tomorrow I am going to get with his office to see if the NCS/EMG for my lumbar is in, and then ask the staff if he read the NCS from the other Neuro, and if so, what are his thoughts. Since I can't feel most of my right hand, and have a numb "band" that follows my Ulnar up to my armpit, I fear that the NCS might be right, and things are going bad fast. To give you an idea Metalneck, I had an 80% loss in strength and "nerve conduction" after my C6/7 went, and surgery was set in 3 weeks!

    In my surgeon's office (and the staff told me this), they don't read the reports when they come in, they just put them in the patient's folder! Soooo I doubt that my surgeon is aware of this latest report. After I get the lumbar report, I am going to call back and ask them to be sure he reads them. Grrr....just getting so frustrated (at my own body, not the doctors). Thanks for listening. *hug* :-)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hey Brenda,

    There is one important thing I think you should know about emg studies. They are not exact science by any means. Most surgeons only use them as a tool and not as the all in all. For example, before my first surgery nothing showed on the EMG, except some carpel tunnel but I clearly had cord involvement. When they did the surgery the surgeon was so happy he called me the next morning like how does that arm feel? The disc was on the cord and clearly the nerve was inflamed. Because I am work comp it is protocol to use them. Now on another set for my legs it shows the peroneal nerve looses signal but the myelo clearly shows the disc is on the nerve and it should show up to the sciatic and follow to that level. I have the peroneal nerve trapped in the other leg but it is from a fracture burst from falling. They did the myelo to find it because it didn't add up with the peroneal nerve but not hitting on the sciatic nerve. Now mind you I have myelopathy which will never show on a emg study. So my point is emg studies have their use, but are not the tell tail sign of it all.

    As far as adjacent disc disease my theory is that is going to only get worse the more times they open you up. I have another disc out but at this point after 5 neck surgeries I am doing everything I can to stay out of surgery. That may not be a choice in the near future, but I just need to be easy. After that many surgeries the scar tissue is mounting and certainly plays a role in all of this. When we do the surgery they are going to add rods in to sure the rest of the levels up. It will take away most of my ROM on the up and down, but continuing to do surgeries is not helping my neck heal either. Each surgery just weakens it more. So you might want to talk to your surgeon about what to do to stop it. Of course nothing is a guarantee but something has to give soon.
  • Tamtam,

    Thanks very much. You're right, most of these various tests are subjective, and too only "parts to the whole puzzle" in the end. I guess the reason I believe this one, is Tuesday I went to a new Neurologist (Latex free office by the way), and after his physical exam he stated that my C8 nerve root was being compromised in a "large" way. He knows about my ulnar being transposed, and when he stated that, he was still looking over my elbow and hand (ring and pinkie). I then asked him, "Couldn't it be scar tissue in the elbow, wrist or hand?" His answer to this was a solid "no" due to this band of numbness I have all the way up my arm. He told me that if it had been in the elbow (as though in a failed Cubital surgery), the numbness would be limited pretty much to the base of my wrist and into the hand specific to the Ulnar. This isn't the case, so at least on a good note, *that* surgery is still good! :-)

    On the 4th I go back up for the upper extremities and upper spine - NCS and EMG for more detail. The NCS (NVC) is gonna be like a second opinion for my nerves if you will. He also mentioned that there seems to be more nerve involvement within the C5/6/7 again! I almost died on that! Yeah, I still have that dang crack all the way across just below the screw from the first hardware, so I just "assumed" it was the C6/7 wiggling around. My guess is after the final electrical study, either a CT or MRI will be back on the list of things to do. Gawd....

    He told me the 'worse case' scenario would be a 'revision' to include adding the C7/T1. :-( If they do have me get another MRI, I can also get a look at how the C2/3 is - I suspect that isn't too good right now either.

    As to things to stop it. I am figuring you are meaning "adjacent levels" from failing? My first one failed just 3 weeks past a year post op, and then the issues started after this surgery around month 4 or so. I don't think there is a way to stop it truly. The good thing I guess is that the thoracic is rigid, so I shouldn't if fused lower, have issues with the thoracic short of the DDD and arthritis I have now, right? Please tell me I am guessing right on that belief?

    My dexterity is changing in both hands, and 'fumble' fingers are common now. The right hand cramps in all manner of ways with no real pattern to when it happens. It varies....ring and pinkie, then later, index and middle, sometimes the thumb by itself, and rarely, but has happened all digits on my right hand go nuts! This just bites, but trying to roll with the punches. Thanks again Tamtam.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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