Howdy folks, I'm just taking the opportunity to say hi.
I've been a skydiver for 19 years, and as you can imagine, sometimes parachute openings are rather violent. About 9 years ago I had one particular bad, while wearing video equipment on my head, that ended my season, showed an obvious herniation on MRI, and resulted in an off-season that included lots of painkillers and at-home traction. It's been getting worse recently and finally in mid June I went to my primary doctor and told him it and unrelated hip problems had become too much to manage. He sent me to PT who would only treat one problem at a time, so I did a month on hips followed by a month on neck, but my PT eventually "fired" me as a patient because she was uncomfortable treating without imaging or a diagnosis, especially given my symptoms.
Symptoms are pain in neck and significant numbness/tingling of right arm, classic C5-C6 (outside of bicep to inside of forearm to thumb/pointing finger). The percentage of each day in which I'm affected has been steadily increasing, now probably >60% and coming in much stronger "waves" almost like a reasonably strong electric shock. After a comedy of errors in the medical admin arena, I finally got an MRI done early last week, then met with a local neurologist to go over findings. He wants a CT scan, a nerve study (EMG?), and to consult with several peers ("blind" email distribution he participates in, I take it) before making any suggestions. I'm going to try to get cortisone from the guy who does the nerve study, but am not terribly optimistic given the duration of the problem. Surgical options briefly discussed were fusion (of course), ARD (likely difficult due to multi-level), and even laminectomy (which sounds absolutely awful). Of course that was just preliminary talk, without enough information to go on yet, but I was impressed with his honesty, including "fusion is basically just turning the hourglass over so it can count the time till the next surgery" and "Honestly, a halfway decent neuro can open shop, have a good first year and average subsequent 5 years, then close the doors to new patients and spend the rest of his career doing follow-up surgeries on his first 5 years worth.
Radiologist readings of most recent MRI and x-rays were as follows:
TECHNIQUE: MR of the cervical spine. Prior study for comparison, December, 2005.
The alignment of the cervical spine mildly straightened but stable in otherwise normal. Signal texture is without fracture or aggressive lesion. There is a marginal endplate changes such as across the C5-C6 interspace, mild marginal productive changes.
No fracture, unexplained edema or organized lesion. Small hemangioma in the posterior aspect of C3 is stable.
Intravertebral disc spaces are somewhat narrowed and the discs are desiccated throughout, most so at C3-C4 and C5-C6, mid cervical spine. No evidence of discitis
The signal texture of the cervical cord is normal and there is no evident intrinsic structural abnormality. There is significant multilevel ventral impact upon the cord, discuss at individual levels below.
The cervical occipital relationships are stable, there is some dural ectasia and scalloping about the posterior occiput on sagittal image 5 series 2 and on image 9 series 2 both sides of midline.
Paraspinal soft tissues, to the constraints of collimation and technique are unremarkable.
The C1-C2 articulation is fairly unremarkable
C2- C3: Neural foramina and spinal canal are intact.
C3- C4: Significant posterior disc osteophyte disease. Mass effect from the endplate measures about 3-3.5 mm impacts the thecal sac, there is some central sparing.
When compared to the prior examination-this has progressed and the ventral cord is probably impacted about the lateral anterior margins.
There is moderate to severe left and moderate right foraminal stenosis, also slightly worse since 2005..
C4- C5: Central protrusion of the disc, impacts the ventral cord on image 12 series 6. Mass effect from the endplate is about 3.5-4 mm. The canal in the anterior posterior dimension measures about 6 mm. This has progressed since the prior examination.
Asymmetric moderate right femoral stenosis, fairly broad.
C5- C6: Lateral disc protrusions, greater to the right of midline, mass effect from the endplate on image 17 series 6 measures about 3-4 mm. Again the ventral cord is impacted.
Spinal canal narrowing is mild to moderate, greater to the intra-right of midline where the ventral cord is impacted.
There is mild to moderate bilateral frontal stenosis, fairly symmetric.
C6- C7: Left paracentral disc protrusion of about 2-3 mm. Impacts the thecal sac, but does not abut the cord.
Mild to moderate narrowing of the right and mild narrowing of the left foramina. Uncovertebral joint disease is explanatory there.
C7- T1: Normal level.
What is seen of the upper thoracic spine is unremarkable
Worsening mid thoracic disc endplate disease, with significant impact upon the ventral cord at several levels
1. Lateral and marginal disc osteophyte disease impacting the canal and cord at C3-C4, with associated foraminal stenosis. Causing mild to moderate narrowing of the canal
2. Central herniating disc protrusion at C4-C5 impacting the central anterior aspect of the canal and cord
3. Right paracentral disc osteophyte complex at C5-C6, abutting the anterior cord to the right of midline. Associated with mild to moderate narrowing of the canal, as well as bilateral foraminal stenosis
TECHNIQUE: Cervical spine series, 4 views
FINDINGS: In the neutral position, there is 1.2 mm retrolisthesis of C4 on C5. Additionally, there is 1.8 mm retrolisthesis of C3 on C4. A prominent anterior disc osteophyte complex is present at C5-6. Vertebral body heights are maintained. There is no prevertebral soft tissue swelling. There is limited range of motion with extension. With extension, there is 2.1 mm retrolisthesis of C3 on C4 and 1.6 mm retrolisthesis of C4 on C5. With flexion, there is resolution of retrolisthesis of C4 on C5. There is 0.9 mm retrolisthesis of C3 on C4.
1. Mild retrolisthesis of C3 on C4 and C4 on C5 as discussed above.
2. No evidence of dynamic instability with flexion and extension.