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A "Best Test" for determining Nerve Root Compression?

LumpyLLumpy Posts: 103
edited 06/11/2012 - 7:43 AM in Neck Pain: Cervical
Okay, I have had a couple of plain MRIs which both showed bulging disks in the area I have symptoms. Of course I have had the standard xrays which show nothing useful. I was supposed to have a CT Discogram, but that looks like it isn't going to happen. Hence, my question. Is there a "best test" to determine nerve root compression?

I have already had a couple of EMGs, but since my problem isn't constant, the EMG only show some minor cervical symptoms. My NS won't do surgery or anything else until he gets more info (which sounds wise to me). I'm going to talk to him as soon as I can, but I thought I would throw it out to the forum in the meantime.
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Comments

  • MetalneckMetalneck The Island of Misfit toysPosts: 1,612
    But the "Best Test" maybe how and what you are feeling.

    Do you have pain and or numbness in your arm(s) and or into your hands - fingers?

    Do you have "shocks" in your arm and or into your hands - fingers?

    Does it feel like someone is sticking a knife into your neck?

    Does it feel like someone hit you across the shoulders with a baseball bat?

    Do you have any leg complications?

    Do medications of any type help?

    Do you have a position of comfort (painfree)?

    Did they say anything about osteophytes?

    Did they say anything about foraminal stenosis?

    EMG's are not considered to be a great diagnostic test. Many surgeons will base their treatments on both the subjective (what you say) and their objective (what they observe such are diminished reflexes).

    Where and how is this neuro planning on getting his additional information? Courier Pigeon?

    Please let us know how you are doing, and what the docs are planning on doing to help you?

    D
    Spine-Health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!  (Click on Welcome to Spine-Health)
    My Story  - Click below
    http://www.spine-health.com/forum/discussion/44804/pain/neck-pain-cervical/long-and-winding-road
    I am not a doctor nor have I ever played one on TV.  Therefore any comments made are based on my experience.
  • I agree with metalneck, all of the things D said are the things I have felt or experienced. my emg was chronic nerve compression, I have pain , numbness in my thumb, neck feels like it could just fall off my shoulders, muscle spasms, ice pick in my neck at times etc. Good luck with finding out what the problem is with your neck, It took eight years for me to finally get the right answers, not that the pain in my neck was that bad for that long but the numb thumbhas been bad for eight years I guess the arthitis was starting then and just recently got really bad. It might take some time to find the right answers!! Lela
  • Sounds like a broken record but what you feel is the best test. Because your pain is intermittant it is extremely important that you keep a journal. Somehow you need to get a good record of what you feel, when it happened, what you were doing.

    Often the surgeon finds different problems when he goes in. So as long as they have a pretty good idea of where the problem is coming from they may need to go in understanding that nothing is set in stone.

    Which area is effected and what are you feeling? While many things can be the source of your pain the usual suspects are often involved.
  • You know, today I am just tire of dealing with it all the time. Having a neck issue is one thing. Having to deal with mindless burocrates at insurance companies is another. One can be cured. The other is just an obstacle. Worker’s Comp is a joke. Rant over for the moment.
    I didn’t post a lot of details because it seems I post the same things over and over again. Symptoms are neck pain (most of the time not muscles). Generally C5C6 and C6C7 levels. I have bulging disks on both levels. Few debate that. I have had a couple of MRIs which appear identical but have drastically different reports.

    As for your questions:
    1. Yes to all. Going by the dermatome map, it follows the C6 and C7 nerve. Aching triceps, pain in forearms on outer side. Aching and numbness in hands. It can be the right side, the left side or both sides, depending on the day. And on a good day, it can be no pain at all.
    2. Shocks, not so much, but occasional
    3. Knife in the neck – yep. Been there, done that.
    4. From shoulder to shoulder, I could draw an imaginary line and it feels like I am sore from a workout some of the time. No baseball bat, though.
    5. No leg issues
    6. I only have a prescription of Hydocodone. It helps some. Ice on the neck seems to help. When the arm aching starts, nothing helps.
    7. Best position of comfort is walking around for a while. Once the pain starts, this doesn’t help much, but if I am on my feet most of the day I feel better.
    8. At C6/7 the MRI reports Medium size broad based central protrusion with posterior osteophytes of disc partially obliterating anterior subarachnoid space. Mild bilateral facet osteoarthropathy and uncinated process hypertrophy. At C5/6 it reports a mild annular bulge indenting the thecal sac. Mild bilateral facet osteoarthropathy and uncinated process hypertrophy. It also reported a mild bulge with a small foraminal protrusion at C3/4 indenting the thecal sac and impinging the right neural foramen.
    9. The other MRI report downplayed all of the above. My NS reviewed both sets of pics himself. He went the conservative route with ESI which works well twice and not so much the 3rd time, though I do suspect it is taking the edge off a little.
    10. When I went for a follow up after the ESI, he basically gave me the choice of living with it for now until it worsens or being more aggressive in finding and fixing the source of it all.
    That’s the short version, believe it or not. My gut says, like Kris pointed out, that the surgeon would be able to see the issues if he cut on me. I am glad he is reluctant to do so, but I can’t do my job without something being done. My NS, BTW, is top shelf – a recognized name and reputation around here and elsewhere. Not that it makes him right. It just makes me trust him more than most.

    Sorry for the long post and thanks for your input. I am considering paying for the test out of my pocket just to get some answers before I lose my job.
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,612
    The N.S. who did my first 3 level ACDF was the best in town and was done at the best hospital around. All of that had little bearing on the outcome.

    After a year of .... gee we can't see whats wrong .... an orthosurgeon throws my MRI up on the screen and said "we need to do the whold shabang".
    (it was music to my ears) WIth you following findings -
    ". At C6/7 the MRI reports Medium size broad based central protrusion with posterior osteophytes of disc partially obliterating anterior subarachnoid space. Mild bilateral facet osteoarthropathy and uncinated process hypertrophy. At C5/6 it reports a mild annular bulge indenting the thecal sac. Mild bilateral facet osteoarthropathy and uncinated process hypertrophy. It also reported a mild bulge with a small foraminal protrusion at C3/4 indenting the thecal sac and impinging the right neural foramen."

    You sound like a surgical candidate to me. But what the heck do I know .... I just shot x-rays and was a paramedic for 5+ years .... and spent the past 25+ training doctors on using EMR's and collecting $.

    I personally prefer orthopedic surgeons to neuros as we have boney problems causing neuro problems ... not the other way around. Let me know what the courior pigeon says when he appears !!!!

    Warmest regards and concerns, (I prefer heat packs over ice)

    D
    Spine-Health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!  (Click on Welcome to Spine-Health)
    My Story  - Click below
    http://www.spine-health.com/forum/discussion/44804/pain/neck-pain-cervical/long-and-winding-road
    I am not a doctor nor have I ever played one on TV.  Therefore any comments made are based on my experience.
  • I like Ice :) I honestly think a lot has to do with this being a workers comp issue. EVERYONE hates to deal with these people. I kind of think the doctors just try to wish us away. Maybe not, but I couldn't blame them. What a faulted system!
  • Dont give up Lumpy, you will find the answers you are looking for!! Keep pushing for them. My primary care doc told me last august that there was no reason for an mri, what did she know, after 3 months of bad arm pain and back spasms I finally went to a neurologist on my own and got the answers I needed, I went to see my ns here and he said surgery! It took months to finally get that answer, no surgery yet as I am doing facet inj, with my pain management doc 2nd one tomorrow, another scheduled 2 weeks after that. My ns surgeon said to me that the bone spurs arent going anywhere, we have to take them out. I guess I am just saying you will finally get your questions answered, they dont know your pain like you do!! Good Luck, Lela
  • I think you started your original post with a statement that the MRI picture is a static image. I wanted to echo that I had a serious nerve impingement in my back while moving, bending, etc. While laying on the MRI table, the impingement must have receded a little and so the doctors looked at it and said that "it's not touching the nerve root". That was an over-simplified assessment, in my opinion.

    I went the surgery route, which, in my cynical mind now, seems to lead to more and more surgery. If it's not too late for you, I would urge you to try to find a PT or Osteo or an MD who can help you resolve the impingement through special exercises that can reduce the bulging disks.

    It may not be possible at this point, but in retrospect, I wish I had given that route a little more time before going under the knife, so to speak.

    Best wishes!
    Dave
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,612
    Nerve impingements caused by ostephytes or foraminal stenosis causing nerve impingement. Disk bulge(s) MAYBE??
    I agree that Xrays or floroscopy in motion (flextion and extension) maybe beneficial in diagnosing what else maybe going on.

    D
    Spine-Health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!  (Click on Welcome to Spine-Health)
    My Story  - Click below
    http://www.spine-health.com/forum/discussion/44804/pain/neck-pain-cervical/long-and-winding-road
    I am not a doctor nor have I ever played one on TV.  Therefore any comments made are based on my experience.
  • Hi everyone,
    I've been reading all your posts and saw what you said about c6-c7 pain being in the tricep, outer forearm, and hand. And although my dr says this is c6-c7 pain, he is going to be doing mine c5-c6 because that is what my MRI shows. Does that sound right to you all?

    Thanks,
    Janna
  • Janna, Of all the confusion I have, one thing I know, the body doesn't go by the chart all the time. Refered pain, overlaps and stuff like that. If you have doubts, it might be worth a second opinion.

    BTW, many times when my neck acts up the ulnar side of my hands have trouble. I have no issues showing on C7T1 disc where the charts indicate. I'm sure it is from my C6C7 and C5C6 issues.
  • Lumpy,
    Yes, that's what I've been told. That my body hasn't read the documents of where it should be hurting! haha. I trust my dr, and he has great hopes and expectations. I am just scared and questioning everything!
    I hope you get the answers you need, and I agree that "insurance" is just red tape. I hope that all gets straightened out for you also.
    Take care.
    I have surgery on the 5th of May, and although I am very nervous, I can't wait for it to relieve my pain.
    Thanks,
    Janna
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