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Neuro Assessment - Neuropathy from C-Spine

2

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  • Well the good accomplishment today was actually receiving copies of the brachial plexus MRI that was done, medical report and cd of the scan, the preliminary emg tech report of my arm/hand, the one of spine to arm done by Neuro will be included in his report (ready next week).

    Re: MRI Brachial Plexus - Results
    Radiology report states,

    "Nerves/Roots/Trunks/Cords: The peripheral distributions of the brachial plexus are normal bilaterally. This includes the nerve root foraminal exit of the nerve roots through and including the passage into the axillary regions bilaterally.

    There is no evidence of mass and no evidence of impingement upon the brachial plexus.

    Visualized Portion of Lungs: The aspices of lungs are normally bilaterally. There is no evidence of Pancoast Tumor.

    Vasculature: The subclavian artery and vein bilaterally are normal with no evidence of aneurysm or AVM

    Associated Bony Structures: Postsurgical changes are seen within the cervical spine with fusion from C-4 thru C-7. There is a hemi-vertebrae on the left at C-3 level and marked scoliosis of the cervical spine convex to the right. There is also significant amount of neural foraminal stenosis on the left C-5/6, C-6/7, and C-7-T-1 due to prominent osteophyte formation about the left-sided facets at these levels.

    The remainder of brachial plexus is otherwise unremarkable.

    There is no compressive abnormality seen associated with the chest wall, supraclavicular area, or axillary region.
    ------------------------------------------------------

    So, I am to assume my neuropathy in my left arm is caused by the osteophytes from C-5 thru T-1.
    No explanation or review unfortunately was done by the Neuro, nor was his focus/time allow for to review these results which were done and in my file ready to review with him!

    I suppose he is leaving it now to me to ask by NS to review and discuss! Which is strange and disappointing since the Neuro is not a referral from my NS, I chose to see this Neuro who could do the MRI of Brachial Plexus and shed light as to primary source of severe neuropathy & nerve/muscle damage in my left hand. ??? disappointing

    Appreciate any input from my fellow spiney's on this!

    Janelle
  • Janelle,

    Howdy! Glad to see you did go over and get the reports from this facility. I am glad to see there isn't additional crush locations in the Brachial Plexus! Due to my "osteophyte complex" at C2/3 they had the significant stenosis tossed in my report.

    The one good thing I am seeing from what you've posted, the spurs aren't causing your disks to push out like I've had happen. That can be seen as a plus, no? "Significant" is a large covering word. Why didn't they mark "moderate or severe" in so far as the level of stenosis. That could be important. So far they've marked mine at what level they were at.

    Any chance you know another radiologist that can read the cervical portion of the MRI, if not all of them from that facility? I say that because they've already themselves to be a bit deceptive or not forthcoming? Just a thought there.

    I am glad to see Brachial Plexus is clear! It is sad that this Neuro didn't see fit to go over the results with you - THAT is part of his job and why we go to Neuros after all - hence the need (or not) to go to the Neurosurgeon. Kind of like I said in PM, I think that they saw you weren't there to fill their money bucket and dropped interest. You wanted a full assessment, which I would think to include if or what kind of surgery might be warranted. He kind of forgot the second half of that equation.

    Thanks for sharing. I would maybe after you've settle back down fully, see if there is a doctor you trust to at least look these films and reports over to be sure all that is possible has been looked at. Chat with ya soon. *HUGZ*

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

    Yes, it was good news to not having second crush to brachial plexus.

    And yes, it truly is unfortunate that the Neuro avoided getting into any revriew/discussion of the source of my neuropathy and prognosis with c-spine surgeries

    I'm thinking he is segregated from that taking the "safe step" with what would involve a NS diagnosis and treatment

    So, is it safe to say now and confirm original assessmenty by the OS, the source and of my peripheral neuropathy is osteophytes on cervical nerves 6/7/8?

    Janelle
  • Sadly Janelle, I have to agree with what your feeling. I do think C6/7/8 (maybe a touch of 5) is the culprit. I know with mine, they are now debating whether the failed fusion for me, or the lesions in the ole gray matter are the primary. I think we will continue the twin mode....that being cervical.

    I just wish he didn't just "drop" the dang ball! Me, I would have given him a tongue lashing, but that is me. I've done it before when I felt ...dropped.

    Just me thinking, if it is for sure the neck, you might want to rethink revision. But I remember when you showed me your ROM, and where it was coming from. As long as it won't mess that up!!!

    You didn't cramp that night with me, but your cramping is so similar to what mine is doing - and we are the same levels, just opposite sides. Like me, you are real good on listening to your body, so you know down deep were the problem is for your (or most) neuropathy. I know my back is causing the legs, no question. Since I can change mine with my neck position, I don't feel "lesions" are doing it, but the neck is. Keep me posted woman!! *HUGZ*

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

    I'm just reading through all this now, I'm glad you got your reports. I was wondering, if it is the spurs that are causing you so much trouble, why can't they go in and remove them? They did with mine, when I had my foraminotomy. That just might help with the neuropathy, it could be a question you could ask? Just wondering out loud here...
    Hope you can get some resolve out of all of this, even if it is just to surrender to knowing that surgery isn't the answer. Take care;
    Kelly
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
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  • Hi, Kelly appreciate your comments...it's been complicated and I have complex issues in my c-spine.

    Situation is: for 7 yrs my OS & I had been monitoring C-5/6 C-6/7 severe progression DDD with ostheophytes and holding off from surgery "only doing if nerve/spinal cord issues". Well in April, I was highly symptomatic with left arm/hand and MRI CTs showed narrowing and shift down overlap of C-6/7 onto T-1. OS set a plan for surgery with hardware junction down to T-1 anterior. But re-assessed surgical prognosis and took surgery off table "not good prognosis, highly unsuccessful outcome - - and two difficult complex procedures to recovery from"

    Factors existing in my case: C-2/3 deformity hypermobile, bone implant fusion surgery levels C-4 thru C-6 from 1995) and neuropathy symptoms most likely would not be resolved with surgery and most likely it would require anterior and posterior complex surgeries with low prognosis of successful resolve of neuropathy (pain and disability in arm and hand).

    I've been in process of getting second assessment with a NS and Neuro, who has surgery treatment for posterior and anterior bridging c-spine into t-spine.

    I've been attempting to safe my hand with elbow and hand nerve disability/damage and determining if I was having double crush there in addition to initial compression to spine.

    Now to current: Confirmed it is no double crush; primary c-spine commpression.

    if it was double crush, hand surgeon was going to do elbow and wrist nerve surgeries to intervene from further neuro damage.

    C-Spine - Complex Surgery required: anterior C-6/7, T-1 and posterior C-5 thru T-2/3 requiring hook up junction of fused C-4 thru C-6 and bridge of C-spine junction into T-spine. Leaving severe scoliosis C-2/3 partial tethered hemi-vertebrae hypermobile and without fusion (too complex with severe curve to consider intervention surgery)

    Kelly, you're probably sorry you asked ! :)

    It's complex all the way around - - decision and facing 2 very difficult engineered surgery with hardware - - junction + bridge hardware "all day surgery" and undergoing procedures together (anterior and posterior) long difficult recovery.

    Second assessment phase very important on neuropathy diagnosis and getting very good NS!

    Janelle

  • and that confirms what OS and NS both assessed C-5/6/7 T-1.

    Now for next big final phase/step:

    Re: MRI CT Scans done 11/23

    Review results with NS; had hoped to have had written radiology reports fax'd and to do with phone consult, but just got a f/u call today saying best done with office appt and also my ENT appt could be accomplished

    (ENT eval was set-up on 11/23 but with scans and Neuro appts and ENT office was behind, it got scrapped)

    NS wants the ENT eval and then review everything with me.

    Sending you a PM re: my trip for those appts. :)

    Then the Final Step....the Big One: The Decision :O

    Janelle
  • Howdy Janelle,

    If you're here in 2 weeks, the hubby and I might be in the RV traveling north - still not sure of the time line as foreman's keep changing the "proposed holiday schedules" ack!

    I can understand the ENT side of it. I did that route already, and will be going back to him soon for the deviated septum, and too to get an update on how he feels my neck is doing (movement wise). I think that is actually a very good move.

    Depending what the ENT finds, could make a huge difference on "The Decision" woman. Keep me posted!! *HUGZ*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hi Janelle,
    I hope you feel better soon and i hope everyone has a great holiday!! This is my story in August of 2008 i suffered from another injury to my c spine the pain was so unbearable i couldn't lift my arms i was expieriencing severe pain in my right hand it felt as if someone was hitting it with a hammer. So i made an appointment with an Ortho doc in September 2008.For some odd reason my appointment was not scheduled until i arrived at the clinic that morning, keep in mind this was a very busy clinic.Anyway when i finaly saw the Dr he had the NERVE to tell me that he reviewd my MRI and everything was in normal limits, the problem i had with this is the MRI was taken in May 2006 after a MVA which revealed mild DDD at C4/ C5/6, this Dr did not bother to order new films even though there was a radiology dept in the clinic.
    So he orders Injections which required that i have a new set of films which revealed modereate to severe DDD at C4/5 C5/6 Bulging at C4/5 C5/6 mild bilateral foraminal narrowing at C4/5 C5/6 mild facet hypertrophy hardly normal to me!! In November 2008 i had the injections done and was off work until June 2009. I went to see my primary doctor in June 2008, she didn't bother to explain the findings to me or to suggest that i may want to consider surgery.
    In fact i was seen by four doctors in that time frame and NOT ONE bothered to tell me the condition of my spine, i was feeling a bit better after the first series of injections and at the time my family decided to move out of state i felt i would be safe so i made the decsion to move to Texas.
    I really thought i would find a good job with health insurance, well i found a part time job with no insurance, and unfortunatly for me i was injured AGAIN. I have been told by three doctors here in Texas that i am and have been in need of an ACDF to C4/5 C5/6 for 2+ years. I am so upset because if i would have known this in 08 i would of had it done then i had the financial means and insurance. My latest MRI revealed bulging at C2/3 C4/5 C5/6, straitening of the lordes curve moderate to severe DJD at C4/5 C5/6 bilateral neuroforaminal narrowing at C4/5 C5/6.
    My Neurologist is recommending sugery asap but due to my circumstances i'm not sure when i can proceed. So yes i have lost a great deal of faith in the profession as well. I appologise that my post is so long.
    Take care!!
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