Neurosurgeon Questions

“Advice”

I recently was diagnosed with severe cervical foranimal stenosis and well as cervical spondolyosis with radiopathy and meleopathy hoffmins test positive all on my right side but strangly im having almost 14 hours a day of numbness mostly on my left from the lower part of my face that radiats to my leg i do have numbness on both sides but primarily left i had a thoratic injury that i informed my surgeon about and told him i am certain that there is more damage than in my neck and would probably make since of whats going on constant armpit and collar bone pain weakness loss of cordination clumbsiness im constantly dropping things at work anyway i told him i wanted an mri of my thoratic spine also and he responded you need to complete pysical therapy before i consider an mri and besides that thoratic pain cant be seen on an mri its kind of like a pandoras box!!! He currently has me on gabapyntin and triazidine i dont take opiod and when they offered them to me i refused im ok with doing the pysical therapy my concern is i was told that if my numbness doesn't go away spreads or gets worse that i needed to call him immediately im worried his passive judgment on my symtoms which mri'cts and 3 doctors have all had same diagnoses that i will end up having permanent nerve damage or worse lose fuction of my arm or more i dont know what to do am i over reacting? Please help also numbness has been going on and progressing fast for a month now disabiling pain for almost a month and a half not to mention im only 39 years and otgerwuse really healthy

Female | 39 years old
Complaint duration: 45 days
Medications: Gabapyntin 300 mlg twice daily triazidine 4 mlg twice daily was told to take 1000 mlgs of tylonal 3 times daily and 600 mlgs of advil 3 times daily also but do not take either one of those i like my liver thank you
Conditions: Severe cervical stenosis cervical spondoyliosis with radiopathy and meleopathy

7 Answers

Your MRI certainly shows narrowing on the cervical spine against the spinal cord. It is hard to gauge from the images how much pressure there is agains the spinal cord. The bottom line is, if you are having clumsiness, dropping objects and being clumsy, that should be addressed immediately, not months later. The thoracic spine does not control the arms, therefore it is inconsequential to the arm symptoms. That MRI can be done later if needed. If you are not happy with your current medical management, seek another opinion. However, I would not wait months to address those symptoms or developing weakness. In some cases it may require going to the emergency room, particularly if you live close to a hospital that has spine surgeons, so they can do an acute assessment.
I can not tell what levels those axial views are of, and there are no foraminal oblique sequences, but the right exiting nerve root does appear to be compressed on those images. If you have progressively worsening weakness of the muscles supplied by that nerve, the nerve should be decompressed. If you only have numbness and pain, then physical therapy and interventional pain management are the right specialists to see first before a surgeon. An EMG would also tell you if you have any motor changes in that nerve that may prompt surgery before first exhausting all of your nonsurgical options.
While it is nearly impossible to provide any meaningful clinical advice online, your condition can certainly be evaluated in office and I am happy to see you as a consultation. In general severe cervical stenosis have sequela that are variable from patient to patient and treatment options heavily depend on physical exam and history.
Good afternoon
Your imaging is concerning, and you may need surgical decompression and stabilization.
In general, Myelopathy, which means symptomatic spinal cord compression will require surgery. A Hoffman sign is worrisome and would go along with that. Seeing your MRI would be very helpful, and I can tell all that much without doing so. If I were you get a second surgical opinion.
I do agree with you that there may be going on than is fully explained by the narrowing in your cervical spine (neck). The myelopathy (spinal cord involved) component related to the narrowing seen on your neck is not trivial. However, there is quite significant left sided narrowing of the specific foramen you have demonstrated on the cross section (axial) views which affects the exiting left sided nerves to the arms/shoulder blades, and surroudning areas. We can sometimes see facial symptoms coming from the neck, but I think you deserve a brain MRI for completeness. An MRI of the thoracic spine is not unreasonable. Physical therapy is a common first approach to painful symptoms involving the spine, but if your neurological impairtment is as bad as you say, then it may be time wasted, and could potentially contribute to more serious and/or more permanent nerve/spinal cord problems that can be possibly irreversible or at least less reversible. Medications may palliate the symptoms (but probably not your weakness/dropping things) on a temporary basis but are not a good strategy for long term amelioration of your problems. I don't think you are over-reacting. It is important to seek as many opinions as necessary to get the care you need, with someone you feel you can develop a healthy and trusting doctor-patient relationship.
Thank you for the question. The imaging does show arthritis in your neck region of your spine. I would expect certainly Right sided arm symptoms as the arthritis is more on the right side. There is moderate central narrowing but the cord is not severely compressed. But it is getting there and given your young age, this could progress over time
If your right sided weakness is worsening in your arm, then you could try a cervical epidural injection to see if that works. If not, then likely a C4-7 acdf or posterior c4-7 fusion or posterior c4-7 decompression alone without fusion may be best