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Old 08-29-2011, 10:25 AM   #1
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Please read -- emg report!!!

Hi all I just received a copy of an EMG report that I had requested.

Here is what is said in the report:

1. NEUROLOGICAL EXAMINATION:

There was atrophy in the intrinsic muscles of the right hand and left foot;

2. NERVE CONDUCTION STUDIES:

The right and left sural sensory responses were absent. The right and left radial, median and ulnar sensory studies were normal.

The right and left peroneal [to the EDB] and tibial motors responses were absetn. The right median and ulnar CMAP amplitudes were reduced. the left median and ulnar motor studies were normal

3. ELECTROMYOGRAPHY:

Needed EMG of seleced right arm and left leg muscles were performed. there was marked, chronic denervation in C8 muscles and mild, chronic denervation in C7 muscles. there was severe, chronic denervation in L5 muscles and mild, chronic denervation in L4 and S1 muscles.

4. CONCLUSION:

a. Right cervical radiculopathies, severe C8 and moderate C7;
b. Left lumbosacral radiculapahies, severe at L5 and mild at L4 and S1;
c. Axonal polyneuropathy, as seen in diabetic and other systemic disorders.

After the test was done the doctor told me that I have 1. Severe arthritis in the cervical and lumbar spines; 2. severe nerve damage in the cervical & lumbar spine and 3. diabetic neuropathy.

One thing that I don't understand is that the conclusion said "right cervical radiculapathies." Most of the pain that I complained about especially in the cervical spine was severe pain on the left side going into the left shoulder region.

As of now I do notice that there appears to be weakness in both arms. I find it tough holding things and carrying things even if they are light in weight.

Any comments &/or suggesions on what was found in the EMG report.

Thansk for listening.

Allan

 
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Old 08-29-2011, 01:37 PM   #2
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Re: Please read -- emg report!!!

Ouch.... You'd need an MRI, though, to tell you if the radiculopathies are caused by osteophytes or by something else like herniated disks. If it's osteophytes (say, of the uncovertebral joints), then it seems fixable by foraminotomies, which would be very good news.

As for sensory problems on the left side when the radiculopathies seem to be on the right side, maybe the MRI will clear that up There may be a structural problem no indicated by the EMG.

As for the axonal neuropathy, that's such a generalized condition that it could cause a whole range of sensory and motor problems, and pretty much anywhere.

Are you planning to get MRI's?

 
Old 08-29-2011, 02:29 PM   #3
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Re: Please read -- emg report!!!

Thanks for the response.

I had MRI's done of the cervical and lumbar spine.

Before I quote the MRI reports; let me just fill you in on the fact that I've been thru spine surgery before.

In the cervical area I had surgery for stenosis then another surgery for "kyphosis" which was a 2 part surgery for a total of 12 hours. Posteriorly they put Harrington Rods in from C3 to about T4 level and then in the anterior positioin a bone graft. Can't remember which levels but I think it is about C3 to C5/6 levels or so.

Then on the lumbar region had surgery for herniated discs then surgery for "flatback syndrome" where Harrington Rods were done from L2 to the iliac crest.

Here are the findings on the MRI reports:

1 LUMBAR MRI:

A. IMPRESSION:

----- Postop fusion from L2-S1. Susceptibility artifact from fusion hardware renders the study non-diagnostic.


2. CERVICAL MRI:

FINDINGS:

----- C3/4 No cord impingement/ There is mild bilateral neural foramina stenosis
----- C4/5 Minor left paracentral disc spur complex. there is no cord impingement. There is no neural foramina stenosis
----- C5/6 Mild endplate spurring. No cord impingement. No neural foramina stenosis;
----- C6/7 Mild disc bulge and endplate spurring. There is no cord impingement. no neural foramina stenosis;
----- C7/T1 Mild disc bulge and endplate spurring. no cord impingement. no neural foramina stenosis

IMPRESSION:

----- Postoperative changes as detailed above; no cord compression; no centreal cana or foraminal stenosis
----- Suspect cord myelomalacia at the C4/5 and C6/7 levels with focal cord atrophy C6/7

The surgeon that I had been seeing is a neurosurgeon. He showed me the MRI film and you could see narrowing on the canal at C6/7.

He was real worried about the findings in the EMG and the MRI.

He was afraid to touch me surgically. He felt in order to get to the affected area it MAY require going in thru the sternum area. He also stated that doing surgery on me would be a "surgeons nightmare."

He also indicated he felt surgery on my was risky for the following reasons:

1. I am diabetic; &
2. I have kidney disease. I was born with 1 kidney; and the kidney I have is only functioning at 30%.

So where do I go from here?

Suggestions? Comments?

Thanks for listening.

Allan

 
Old 08-29-2011, 02:41 PM   #4
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Re: Please read -- emg report!!!

pb - I have had three surgeries and you make me look like a rookie!

I can't reply right now, but can you say what kind of cervical surgery you had "for stenosis". Since you had to follow up "for kyphosis", I'm guess it was a laminectomy? Whatever it was, it didn't interfere with the MRI, like your lumbar hardware did...

 
Old 08-29-2011, 02:48 PM   #5
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Re: Please read -- emg report!!!

Let me add... your cervical MRI looks pretty clean (except for the myelomalacia), don't you think? Whatever surgery you had before must have cleared it up.

The myelomalacia, though, must have been caused by a severe problem of some kind before the operation. I have a bit of it around C4, which was caused by a badly herniated disk 15 years ago. Could myelomalacia possibly be the result of diabetes?

And what surgery would go in through the sternum? Not lumbar or cervical, as far as I know...

Last edited by WebDozer; 08-29-2011 at 02:51 PM.

 
Old 08-29-2011, 02:49 PM   #6
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Re: Please read -- emg report!!!

Hi here are the surgeries that I have been thru.

1. 1994 lumbar region for herniated discs; laminectomy;
2. 1995 cervical region for stenosis; foramina stenosis;
3. 1997 lumbar for flatback syndrom which included putting in harrington rods;
4. 2000 cervical for Kyphosis 2 stage surgery rods and fusion anteriourly
5. 2006 spinal cord stimulator implanted
6. 2011 spinal cord stimulator removed

They had to take out the stimulator to get the MRI done plus the stimulator wasn't working for me anyway.

It's strange they were able to get the cervical MRI with the Harrington Rods but for some reason they couldn't get a view of the lumbar area with the Harrington rods. Not sure why the rods interfered in the lumbar area but able to get impressions on the cervical area.

Just a note I have been thru 2 other surgeries unrelated to the spine. I had a blood clot in the left leg and had surgery to remove the close and went thru surgery for pancreatic cancer for mass; I beat the pancreatic issue. They got the mass in time before it bacame malignant and spread.

 
Old 08-29-2011, 02:56 PM   #7
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Re: Please read -- emg report!!!

The concern with the Cervical MRI is that there is cord atrophy and narrowing on the spinal cord at C6/7. that is the big issue.

I get radiating pain in both shoulders mostly the left though. And upon examination the doctor who I have been seeing for 6 years or so has noticed diminished neurologically for me. And holding things my arms get weak as anything.

As to the lumbar while the recent MRI didnt show anything cause of the rods prior MRI's showed stenosis at the level above where the rod starts.

I have severe numbness in my left leg from the knee down. Trouble sitting for long times; trouble walking distances; at times it feels like I am walking on stones probably cause of the diabetes.

I get a crushing feeling in the spine sometimes the entire spine.

It's an ongoing situation. the surgeon was real worried about the MRI.

As to the surgery he felt with all that had been done the only way to even get to the area in the neck may be thru the sternum

Im trying to get a 2d opinion. See what happens But its not good day to day.

 
Old 08-29-2011, 04:11 PM   #8
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Re: Please read -- emg report!!!

I don't understand. The radiologist says NO CORD IMPINGEMENT at any cervical level, and no foraminal stenosis from C4 to T1. What is there to operate on?

If you have CANAL stenosis (congenital?) rather than foraminal stenosis, and your lamina are intact (you have not yet had a laminectomy or laminoplasty), I wonder if a laminoplasty might help? It would give the cord some space to migrate backward to escape impingement from the front. Normally, kyphosis is a strong counterindication for laminoplasty, but with the Harrington rods in place you might be OK.

Anyway, I VERY MUCH agree that you need more opinions. The best surgeons possible, even if you have to travel.

Best of luck, and I'm sorry for your bad day...

 
Old 08-29-2011, 04:30 PM   #9
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Re: Please read -- emg report!!!

I'm really not sure what to add. The neurosurgeon was concerned about the central canal at C6/7 and the narrowing. The report said cord atrophy and I think that is part of the issue plus the findings in the EMG.

To my understanding any narrowing on the canal is not a good thing.

I've been trying to figure out who to use and who is on my plan but hesitate just picking a doctor because of the hospital he/she is affiliated with.

I have a neurologist locally that is supposed to be good. Trying to set an appointment.

Between the findings on the EMG and the MRI i know the way I feel. I've been doing this for 23 years already.

Not sure what else to add but the quality of my life has been drastically affected by everything

 
Old 08-29-2011, 04:35 PM   #10
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Re: Please read -- emg report!!!

I understand that cord narrowing is not good, but the radiologist doesn't mention a single thing that might be the culprit, and hence operable. Maybe the surgeon you talked to sees something the radiologist didn't see. It happens.

Hang in there... I can tell you are handling all this a whole lot better than I would, so good for you.

 
Old 08-29-2011, 04:44 PM   #11
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Re: Please read -- emg report!!!

I agree sometimes between what is written and what is seen on the film is 2 different stories. That's why I want 2nd or 3rd opinions to look at the reports; the films then ME.

I wanted a second opinion from a neurosurgeon who was supposed to be top notch.

He read the reports; didnt see the films and didnt see me.

He said, via his nurse; do nothing.

this is not the way to practice medicine. You need to look at the entire package and not just a drive by and a quick glance at one of the pieces of the package.

the doc didn't see the films; didnt see that their are neurological deficits which was seen by my neurosurgeon. And he didn't see the quality of life and the complaints.

Needless to say I wouldn't recommend a surgeon that practices medicine this way.

More later. Thanks for listening.

 
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