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Old 11-24-2011, 10:53 AM   #1
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Confused with EMG results - What now?

Background:

Foraminotomy - L4-L5/L5-L6 - bilateral - 4/2010
Foraminotomy - C5-C6 - 12/2010
Fusion - C5-C6 - 5/2011

Still experiencing pain, numbness and tingling in hands and left foot, the Dr sent me a myelogram. Nothing was seen on the myelogram so the Dr sent me an EMG (cervical and lumbar).

This is what happened prior to the lumbar surgery, nothing was seen corresponding with my symptoms on the myelogram so an EMG was done. The results from the EMG at that time was the reason for the surgery.

Now, with this new EMG, I am so confused on what will happen next. I'm tired of surgeries...mentally and physically. Tired of being in pain!

Here is the conclusion of the testing:

Cervical EMG:
This is an abnormal study. This study demonstrates a Subacute-Chronic C7 Radiculopathy on the right side. There is also the presence of a Median Entrapment at the bilateral wrists, consistent with Carpal Tunnel Syndrome.

Lumbar EMG:
This is an abnormal study. This study demonstrates a Chronic S1 Radiculopathy on the left side.

Still waiting to hear back as to when I go back to the Neurosurgeon. So was hoping someone would have some insight or thoughts on this.

At my wits end!

Thanks and I wish everyone a Very Happy, Healthy and Safe Thanksgiving!

 
Old 11-24-2011, 12:57 PM   #2
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Re: Confused with EMG results - What now?

devkar - I'm not sure why you are so frustrated. Your numerous foraminotomies would seem to indicate that your have a chronic and widespread problem with osteophytes growing into your foraminal openings. Is there any indication that your current apparent radiculopathies are any different? After all, they are occurring at levels adjacent to those previously operated on. Won't further foraminotomies address your problems?

My experience with foraminotomy (only one, C5, in 2004) was quite positive. Outpatient surgery, with little resulting pain, and pre-surgery symptoms cleared up.

I am curious to know about your prior experiences, if you don't mind. What were the symptoms, did you have to stay in the hospital afterward, what was the recovery period like and what happened to those pre-op symptoms?

Last edited by WebDozer; 11-24-2011 at 12:58 PM.

 
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Old 11-24-2011, 01:51 PM   #3
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Re: Confused with EMG results - What now?

Webdozer...Thank you for your reply.

The surgeries were a result of an injury in 2006. A 265 lb man fell on top of me and apparently the way I went down onto the concrete twisted my spine up in different areas. I guess I am frustrated because I am tired of dealing with these symptoms and pain for the past few years. Seems like it's never ending. Each time I have surgery, it clears up the one area, then something else seems to irritate me.

As far as the surgeries...For all 3, I was in the hospital for 3 days for each. Prior to the lumbar surgery, I had foot drop in the right foot and pain throughout the leg. The surgery was quite successful with no post op pain and immediate relief of the foot drop. My Dr. was quite surprised with this, as he gave me a low percentage of possibilities of getting my right foot back to normal. My frustration is now that I have to deal with the same symptoms on the left side. Kinda discouraging.

With the cervical surgeries, the first was unsuccessful as to the need for the fusion. I haven't seemed to have had any relief with the neck symptoms. No relief from pain, numbness and tingling in the arms and hands. It started in the left and is now in the right as well. With complete loss of strength in the left.

However, I am completely happy with the outcome of all the scars. They all healed so nicely and barely noticeable. I had a problem with being allergic to the bandages with it burning the skin. But after that all cleared up...all is good!

I feel like I bounce back pretty well after the surgeries. After each surgery, within 2 weeks I was put in physical therapy. Post-op pain wasn't so bad...just the nerve pain that hasn't subsided has been the major complaint.

Just seems like every time one thing is fixed, something else goes. I was a runner prior to this...now, I can hardly walk at times. I hope you can understand my frustration there.

Hope you are enjoying your Turkey Day! And thanks for allowing me to vent.

 
Old 11-25-2011, 05:20 AM   #4
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Re: Confused with EMG results - What now?

So the cervical foraminotomy didn't work? Do you think it was the wrong surgery, or maybe just not done well.

I'm very surprised at 3 days in the hospital for those foraminotomies, especially the cervical. After mine, they would've had to handcuff me to the bed to keep me there for more than a couple of hours. 3 days is a long time for any cervical surgery, for that matter.

I'm also a little puzzled about all this being caused by trauma. Usually, foraminotomies are to remove osteophytes that have grown into the foraminal openings with time. Apparently this was not the case with you?

As for scars, my foraminotomy and ACDF left very little. The scar from my cervical laminoplasty is a whopper. Not at all attractive. Still, I'd rather have a bad scar and a successful operation than the other way around...

 
Old 11-25-2011, 06:14 PM   #5
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Re: Confused with EMG results - What now?

I have the ultimate faith in my neurosurgeon so I wouldn't say he did a bad job with the first one. A post-op MRI showed no more bulging after the foraminotomy then after 2 1/2 weeks of physical therapy something didn't feel right. So they send for another MRI and another bulge, bigger than previous, was seen. So they went back in.

I had no issues with my back and neck prior to this incident. Had previous MRI's and there was no damage until this. With having damaged discs in 3 different areas, my Dr explained that the foraminotomies were the best route to go due to the fact that he didn't want to fuse too many damaged discs together as I would lose mobility.

Not being a Dr and having gone for a 2nd opinion who agreed with this Dr...I'm confident he knows what he is doing. Although both Drs explained that the discs below the surgical areas would eventually go...I wasn't expecting it so quickly.

I am now going back on Monday to see what he says...so I'll update then.

Enjoy your weekend.

 
Old 12-04-2011, 09:36 AM   #6
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Re: Confused with EMG results - What now?

UGH! Still no answers! Sent me for an Xray and now the following impressions for lumbar and cervical:

No solid cervical fusion at C5-C6.
Slight anterior slippage of C4 over C5 with flexion.
Mild narrowing of C2-C3 disk space.
Minimal spondylosis L3-L4 with limited motion.

This is driving me crazy. Would love one day without pain!!!

I'm at the point that I truly want to end everything!!!

 
Old 12-04-2011, 09:47 AM   #7
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Re: Confused with EMG results - What now?

There's only so much they can tell from an X-ray. I wonder why they didn't send you for an MRI, as the EMG quite specifically indicated radiculopathies that might explain the hands and feet problems.....

 
Old 12-04-2011, 06:07 PM   #8
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Re: Confused with EMG results - What now?

I think it depends on what part of the country you live in as to whether you will receive a foraminotomy as a stand-alone procedure. I cannot speak about cervical procedures, but lumbar foraminotomies tend to only resolve the pain for a short while. The procedure can be repeated to open back up the space so the nerves can pass unimpeded, but usually this will result in instability as more bone is removed, and eventually a fusion becomes necessary.

An x-ray isn't going to reveal any soft tissue issues, so it really doesn't give a good idea of what's going on. Have you had flexion/extension x-rays to check for instability? This is the best way to see a spondylolisthesis.

 
Old 12-05-2011, 09:11 AM   #9
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Re: Confused with EMG results - What now?

hey teri, it would appear that the above x ray results WERE done by flex and ext x ray. just reading that second finding where it mentions 'slippage of 4 over 5 WITH flexion would appear to be an actual flex and ext type of x ray done(also the BEST way to even "see' fusion esp in c spine). i too feel that this type of an x ray alone can show sooo much more in some cases than MRI and CT only because of what this will show AND what was my own experience with non fusion as well. my "alleged" fusion was NOT at all fused back in 02 and both MRI and CT, well MRI was inconclusive for fusion and recommended a CT for 'better clarity of this area",and turned out IT stated i WAS most definitely fused, and at BOTH endplates, when both my primary and myself(just HEARING the insane popping and bone grinding and intermittant radicu symtoms all stemming from my neck) KNEW i was not. it was not until that flex and ext x ray was FINALLY done that it just showed VERY plainly and clearly that i was NOT at all fused at BOTH endplates, just one. i still totally believe that ANY post ACDF patient, esp in that c spine just NEEDS to have that type of an x ray vs ANY other type of scan to check for full fusion and any other more 'structural issues, since this x ray simply shows what goes on within that c spine upon real actual movement. no other 'scan' does that BUT this type of x ray either. it can show the 'gapping between endplates(even with hardware in some cases), and 'slippage as the above results state too, as well as ANY actual movement of the verts that show whether or not they are ALL attatched to each other as they should just 'be'. even the way the boney prominences simply DO 'fan out' at the posterior side show a TON when they either 'stay together upon movement of flex and ext(means fusion has taken place), or fan back out again like they should NOT after a good solid fusion has taken place. i just personally feel that the flex and ext just can show sooo much more when it comes to looking for any fusion, esp that c spine where it is simply seen much more clearly(in a few different ways) when that neck is moved forwards and backwards. and it DOES appear just based upon your x ray results that you still DO have some structural issues there devkar.

you just have an 'incomplete fusion' at that c 5-6 which trust me, just CAN create a ton of radiculopathic crap since that area(bone plug and the 'non attatched vert) is simply 'moving around' and hitting nerve and who knows what else only because there is NO solid anchoring in there right now, not to mention the instability that just comes with this too. that 5-6 NEEDS an anchoring plate and screws placed(at the very least) to maintain full contact between the trying to fuse together endplates. this is what they did for my c 6-7 when only my top endplate fused. this was done 9 months post ACDF and by the time i had to have my spinal cord surgery from posterior into that cord, my NS who did THAT ugly surgery told me i had finally fused and good solid fusion. this was visualized with HIS own eyes and not a scan, so i tend to believe him. but that area will remain kind of unstable and also mobile until it IS better anchored together for enough time TO actually capture endplates and then fuse together. but generally, that plate and screws just DOES still always stay in your c spine and not removed. mine still is there. it also DOES help in the longrun too just to keep that level much more stable.

i am also kinda curious if that c 4-5 has some type of issue within ITS endplates as well as it mentions actual 'slippage of 4 OVER 5, ONLY with flexion??? while haveing anterior or posterior slippage is kind of a more normal finding, this actually occuring only upon actual MOVEMENT is not. anyone can have slippage, esp when the normal lordosis is lost(when that loss occurs our verts will "stack up and carry wieght wrong vs 'normal" lordotic curve just being there. also very common finding. i have it) and the verts can kind of 'migrate either forward or back wards over time, BUT are STILL well anchored together at the endplates which this kind of 'sounds' like is NOT the reality here since it mentionsONLY 'upon flexion?? your NS NEEDS to explain THAT one to be certain that that area somehow is either not attatched or just that whole area kind of moves becasue of the lower C5 -6 issue? just could be two totally different reasons for this. one more minor and one more major.

with the exception of what DOES appear to be bilateral median nerve impingment within that carpal tunnel(that median nerve IS the ONLY nerve that actually passes thru that carpal tunnel) that could be very much responsible for any 'hand/finger' symptoms, totally depending upon just 'what' is being impacted there as in fingers and possible fine motor affectation anytime a c spine level nerve down there IS being impacted too. but that c spine really NEEDS some rather immediate attantion to at the very least here, stabilize the non fused endplates at C 5-6.

i would 'think' and this is kind of based upon what i felt during MY non fusion. that you would be hearing and feeling some level of actual bone grinding going on within that neck area that if this is anything like mine was, you and other people CAN actually hear as well?? my primary could hear this crap even standing like two feet away only when i started moving my neck around. plus, that unstable non attached area very easily can be moving and shifting around in there enough to also be 'intermittantly' impinging, or simply hitting nerve up there too which would crreate more intermittant and not really constant types of radiculopathic symptoms, depending. i kept repeatedly having my thumb and my forefinger on my R side hand going numb, zingers and just pain every so often, and not a more 'constant/24/7' type thing? but alot depends too upon just how inflammed the 'hit' nerves become too? pain would more than likely be a bit more of a constant(just how inflammation is) while once that plug/endplate moves, the actual numb feelings would tend to relieve themselves once that 'impinger' is off that nerve kinda thing? but anything up there, depending upon specific movement just also 'could' end up kind of 'jamming up' or lodging itself either onto or around a particular nerve too. and that could give more constant symptoms. but ongoing pain just begins once the nerves simply start getting angry at getting 'attacked" over and over agin so the inflammatory cycle begins with esp pain.

and i really am not too certain just exactly what is the issue with that slight 'slippage' upon movement at your c 4-5? this as i mentioned before, just could be the way that c 5 just 'is' or a totally different issue going on there too. but more than likely, depending upon if only one or both endplates have not fused at the ACDF site, you could have ALOT of overall movement going on there or just 'some' that if this is only 'some' i am willing to bet the unanchored/non fused area IS at that c 5 level, just because the level above it is even moving at all? OR simply 'just' that 5 OVER the 4.

unfortuently this may need some surgical intervention to try and stabilize that 5-6 area with more than likely some hardware(usually titainum plate and screws on the anterior side to act as kind of a "splint' that stays in). how long ago was THAT surgery done again, i of course forgot(or was not mentioned? and at 'some' point, that CP needs some attention too. are they ABSOLUTELY certain that your carpal tunnel IS the underlying culprit there? that median can also be somewhat affected by that c spine level too, only because it STARTS at the c spine level at all? or you could have symptoms in the hand from 'both' too. that c 6 innervates mostly that thumb and forefinger with the another area that i have to recheck on carrying the fine motor aspect OF it. all of the c spine nerves just ARE 'multinerves' unlike the from T on down where they have two nerves at each level, a sensory and a motor, the c spine levels only have ONE on each side at every level that are a 'multi' nerve. the insane thing here tho is that while the dermatomes are dead on for sensory, the actual fine motor(muscles of dexterity) part for innervating finger muscles are NOT at all on that same nerve. it stems from one of the OTHER c spine nerves. as an example, my ulnar/c 8 nerve was severely damaged during my spinal cord surgery and i lost sensory in the ring and pinkie(normal) but my fine MOTOR movement/losses are affected totally on more of that thumb side. thats how strange the c spine is innervated. if you look up the 'peripheral nervous system", it does explain things there much more clearly. i just cannot recall what fingers are fine motor attached to that c 6 off hand.

but you DO need to talk with your NS about a few things here. you just cannot continue to walk around and do certain things with a totally non fused c spine level. THAT does need some type of intervention before something worse just could occur, even with a simple fender bender type accident, esp if an airbag gets deployed into your face. that IS one of my bigger fears only because of how messed up and unstable(cannotbe fixed) my own c spine actually is right now. just DO make an appt to speak with your NS about the flex and ext and EMG results. he should be able to come up with some type of actual plan of action here. good luck devkar. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
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