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Old 09-07-2012, 12:19 PM   #1
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Positive cervical MRI, negative EMG/NCS confused...

Hi there, I was broadsided in a car accident in July 2010. I slammed on the brakes to avoid but he hit me in the front third of my car hard enough to push me up onto the curb and total the car. I had xrays in the ER, chiropractic and limited additional medical care (ER) due to not having health insurance. Neck pain got so bad recently after attempting to resume normal daily activities (close to 2 years post-accident) that I saw a nerologist on lien against the insurance settlement.
MRI results: There is straightening of normal lordotic curvature. There are no fractures, subluxations or destructive changes. Bone marrow within visualized bony structures demonstrates relatively normal signal intensities.
There are no abnormalities at the cervicocranial junction. Cervical cord does not show any focal enlargements or focal areas of abnormal signal intensity.
C2-C3:There is no indication of posterior disc protrusion. There is no evidence of central or foraminal stenosis.
C3-C4: same as C2-C3
C4-C5: There is a moderately significant degree of central stenosis secondary to combination of short AP diameter of the spinal canal and 3mm broad-based posterior disc protrusion causing pressure over the anterior aspect of the thecal sac and pressure over the anterior aspect of the cervical cord.
C5-C6:the same as C4-C5, with the addition of mild to moderate narrowing of both neural foramina.
C6-C7: There is a mild degree of central stenosis secondary to combination of short AP diameter of the spinal canal and 2mm broad-based posterior disc protrusion causing pressure over the anterior aspect of the thecal sac.
Symptoms include shoulder pain, neck pain and stiffness with fierce headaches that start at the back of my head and work their way around and above ear, pain radiating to mid-upper right arm often, and frequently forearm pain just below the right elbow (flares with attempts to straighten arm), and electric shock like sensations across top of hand and down middle finger, also experience mid-upper left arm pain but not both sides at the same time. The arm pain is not constant, neck/shoulder pain to some degree is constant. Based on MRI results neuro said I needed surgery, that I risk paralysis if injured in that area again. After EMG/NCS was negative (his words "not that bad", my pain was level was low that day), he dialed it back to probably won't need surgery but definitely get epidural injections, which are scheduled to start later this month. I am confused, as my insurance case is pending and I am on the hook for $5000 per injection. Is it possible to have nerve problems with a normal EMG? I am in pain most of the time, with fairly regular flares that put me down for a few days. I am hoping the injections help but at the same time I don't want to commit to the expense if they aren't going to help me. Any input would be greatly appreciated! Thanks

Last edited by kme1971; 09-07-2012 at 12:22 PM.

 
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Old 09-08-2012, 09:42 AM   #2
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Re: Positive cervical MRI, negative EMG/NCS confused...

I would say that your MRI is rather ambiguous as far as needing surgery goes. One thing I would bring to your attention is the "secondary to.... short AP diameter". What he's saying is that your spinal canal is abnormally small from front to back. This is likely caused by short pedicles, which are the bony connections between the vertebrae and the lamina. If you find an illustration of pedicles, you can see that if they are too short, then the spinal canal will be narrow, as will the foraminal openings. This is a condition called "hereditary spinal stenosis", which I also have. The important takeaway here is that having an abnormally narrow canal, and probably also abnormally narrow foramina, means that when things go wrong (or just gradually deteriorate over time), you have less leeway in your canal and/or foramina, and the spinal cord or the spinal nerves will be more readily affected.

In your case, the disk protrusions are pressing into the canal (which is lined by the thecal sac), and your lack of leeway means they are also at least slightly pressing on the spinal cord. What's uncertain is how much effect this will have symptomatically. Spinal cords can be deeply indented or compressed with few or no symptoms, or they can be only slightly compressed with multiple symptoms.

The shock going down into your right middle finger would seem to point to a problem with the C7 nerve, which passes through the C6-7 foramen. That does not necessarily mean the problem is in the foramen (the radiologist does not mention any problem there), as the nerve also could be pinched in the shoulder or elbow.

I'm afraid that, from what I've read, everything is kind of up in the air. I couldn't say for sure that spinal problems are to blame, and I couldn't say that they aren't. I would GUESS that your MRI images look at least a little worse than the radiologist's report makes it seem, or the surgeon would not start out by saying you need surgery.

Still, some of your pain could be due to strained muscles, which can be very painful and also last a long time.

If you can, I'd suggest your get more opinions. You could send your MRI to a different radiologist. You could also see another spinal surgeon or neurologist. That might clarify things.

Good luck....

 
Old 09-08-2012, 08:57 PM   #3
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Re: Positive cervical MRI, negative EMG/NCS confused...

What you describe here is called chronic neck pain. When pain persists more than 6 months it's called chronic and it never goes away. In fact, it get worst as years go and will have Osteoarthritis of your neck in the future.

It looks like your tendons, ligaments and muscles got damaged and once they get damage there is nothing to do about it----it's called soft tissue damage.

ONe last thing, never ever go to a chiropractor. THey will destroy your neck. They can cause bulging and herniated disks. So why going to them?
They can tell you they will fix your neck....But they cannot fix it.

Neck surgery cannot fix damaged tendons, ligaments and muscles. so the pain will be with you forever. I have the same problem.

 
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