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Posted on Mon, 31 Jul 2017 in Brain and Spine
Question: History: for about a year I have had the onset of numbness in both hands but that numbness has worsened over the past year so that now involves both pain and burning type of pain primarily in the fifth digit, began first on the right side but now it is involving the left hand also.
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Primary Doc thought I had a “pinch nerve" with the arm and possible ulnar neuropathy or median neuropathy
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Had MRI with report
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EXAMINATION: MRI Cervical Spine Without Contrast     TECHNIQUE: Sagittal T1, T2 and STIR. Axial T2 and Gradient-Echo
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C4-C5 FINDINGS:
1- moderate disc space narrowing with moderate spur disc complex causing moderate central stenosis and cord compression.
2- Some high T2 signal in the cord on either side just below disc space level suggests myelomalacia.
3- Moderate left and moderate to severe right foraminal stenosis
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C5-C6 FINDINGS:
1-Moderate disc space narrowing with broad-based spur disc complex greater to left of midline causing moderate central stenosis
and cord compression worse to left of midline,
2- At the upper C6 level there is high T2 signal on either side of midline w/in the cord probably myelomalacia.
3- Mild left and moderate right foraminal stenosis.
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C6-C7 FINDINGS:
1- Moderate disc space narrowing and broad-based spur disc complex causing moderate central stenosis without cord compression.
2- Mild right and moderate left foraminal stenosis.
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C7-T1 FINDINGS:
1-mild degenerative disc & endplate change
2-mild bilateral foraminal stenosis. w/out significant central stenosis.
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30 Day Delay in Surgery Analysis
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Feb 1- Diagnosed with Cervical Spondylosis with Myelopathy (CSM) from compression of the spinal cord that caused me ONLY sensory dysfunction in my hands
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On March 1- “burning” nerve pain symptom’s location:
1- primarily in the Right hand’s “Pinky”
2- slight “burning” in the left hand’s “Pinky”
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Delay in surgery 30 days,
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On April 1 - “burning” nerve pain symptom’s location:
1-Same as Above with Increased level of “burning” pain
2- the ENTIRE dorsal ulnar cutaneous distribution in BOTH my left and right hands extending THRU-OUT the entire sensory territories of the ulnar portion of the posterior aspect with INTENSE “burning” nerve pain symptoms
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NO other part of my body was affected!
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QUESTION 1- From the MRI info, What possible reason(s) would explain this
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QUESTION 2- Can you explain the possible reason(s) for The Effects of wearing a "Hard Collar"
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From the moment I put it on and raised the chin support, each “click” of the adjustment “knob” raised my chin and “stretched” my neck upwards about one-quarter of an inch per “click.”
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Each “click” stretched my neck upwards; taking more of the weight of my head off my neck. Several “clicks” in effect “mimicked” what cervical decompression surgery with ”fusion” would do by what "could only(?) be explained as allowing the nerves to decompress.
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For 6 MONTHS, I could feel, a noticeable reduction of the burning nerve pain
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However, in that SAME ONE (1) MONTH
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I felt a dramatic REDUCTION in the collar's effectiveness to relieve the severity of my CSM symptoms
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With all due respect, Please NO copy and paste answers-
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Thanking you in advance
doctor
Answered by Dr. Bruno Mascarenhas 59 minutes later
Brief Answer:
Both Questions are answered

Detailed Answer:
Hi,

Welcome to HealthCareMagic.com I am Dr.J XXXXXXX Anto Bruno Mascarenhas. I have gone through your query with diligence and would like you to know that I am here to help you.

QUESTION 1- From the MRI info, What possible reason(s) would explain this
The Cervical Spondylosis can cause this by
1. Direct Compression of the Roots and / or cord
2. Interference in Blood Supply to the Roots / and or Cord by compression of Arteries or Veins
This can explain your symptoms

QUESTION 2- Can you explain the possible reason(s) for The Effects of wearing a "Hard Collar"
Hard Collar relieves the Compression
So there is temporary relief

Hope you found the answer helpful.

If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions.

Best Wishes for Speedy Recovery
Let me know if I can assist you further.
Take care.

-oOo-

PS 1 : After all your doubts have been cleared, kindly (a) Close this Question (b) Rate my Replies and (c) Give your Feedback.

PS 2 : In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at http://bit.ly/askdrbruno
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Bruno Mascarenhas 43 hours later
THREE (3) FOLLOW UP QUESTIONS TO MY "QUESTION 2"
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REVIEW-MY QUESTION 2 WAS - Can you explain the possible reason(s) for The Effects of wearing a "Hard Collar"
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YOUR ANSWER: Hard Collar relieves the Compression, So there is temporary relief
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FOLLOW UP (1) TO QUESTION 2: relieves the Compression OF THE COMPRESSED NERVES?
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FOLLOW UP (2) TO QUESTION 2: Since the "burning" nerve pain symptom is ONLY in my "pinky" (fifth digit) area that is innovated by the C8 dematome, may I "Assume" that is the C8 nerve root that is being compressed?
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FOLLOW UP (3) TO QUESTION 2: Or is the nerve "compression" in the cervical spinal cord BEFORE it becomes the C8 nerve root?
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THANKING YOU IN ADVANCE
doctor
Answered by Dr. Bruno Mascarenhas 30 hours later
Brief Answer:
All Queries are answered

Detailed Answer:
//FOLLOW UP (1) TO QUESTION 2: relieves the Compression OF THE COMPRESSED NERVES?//

Relieves
Compression of
1. Nerves
2. Spinal Cord
3. Blood Vessels to Nerves
4. Blood Vessels to Cord

//FOLLOW UP (2) TO QUESTION 2: Since the "burning" nerve pain symptom is ONLY in my "pinky" (fifth digit) area that is innovated by the C8 dematome, may I "Assume" that is the C8 nerve root that is being compressed?//
No
It can be also a vascular compression

//FOLLOW UP (3) TO QUESTION 2: Or is the nerve "compression" in the cervical spinal cord BEFORE it becomes the C8 nerve root?//
Compression can occur at one or more levels
1. Nerves
2. Spinal Cord
3. Blood Vessels to Nerves
4. Blood Vessels to Cord


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Bruno Mascarenhas 10 hours later
ADDITIONAL FOLLOW UP QUESTIONS
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REVIEW:
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February 1 Doctor Diagnoses me with: SPONDYLOSIS With MYELOPATHY
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March 1, - Scheduled C4-7 POSTERIOR LAMINECTOMY AND FUSION Surgery
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On March 1- I have “burning” nerve pain symptom’s location:
1- Intense in the Right hand’s “Pinky”
2- Slight in the left hand’s “Pinky”
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On March 1- I have “Numbness” symptom’s location:
1- Complete in the Right hand’s “Outer Palm”
2- Slight in the Left hand’s “Outer Palm”
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Doctor Delays my surgery for 30 days,
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On April 1 -I NOW have “burning” nerve pain symptom’s location:
1-BOTH Pinkies have INCREASED level of “burning” pain
2- NEW AND ADDITIONAL “burning” nerve pain symptoms in the ENTIRE dorsal ulnar cutaneous distribution in BOTH my left and right hands extending THRU-OUT the entire sensory territories of the ulnar portion of the posterior aspect with INTENSE “burning” nerve pain symptoms
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On April 1- I have “Numbness” symptom’s location:
1- Complete in the BOTH hand’s “Outer Palm”
2- ALSO both Outer Palms NOW have “burning” nerve pain symptoms
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QUESTION 1: What could explain this "rapid" spreading in the location and intensity of these symptoms??
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QUESTION 2: If the C4-7 POSTERIOR LAMINECTOMY AND FUSION surgery been performed on March 1, would it have PREVENTED these symptoms from "spreading"? Please Explain
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THANKS
QUESTION 3: the fact that the Hard Collar with it's adjustable chin support gave me "Relieve" from "burning" nerve pain from February 1 thru March 1 and then it's "effectiveness" Decreased from March 1 thru April 1 as the nerve pain and numbness symptoms increased suggest that if the surgery with fusion had been performed on March 1, that the surgery with fusion would have stabilized my condition and prevented the nerve pain and numbness symptoms from spreading? QUESTION 4: is spondylosis with myelopathy, A syndrome, condition or disease?,
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QUESTION 5: Would this be a correct phraseology, that on March 1 the "cumulative effect" from my spondylosis with myelopathy (condition?) was an intense burning nerve pain in my two pinkies and
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that during the month of March there was a rapid deterioration in my spondylosis with myelopathy (condition?) which caused a rapid spreading in the nerve pain and numbness symptom locations and intensity such that
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on April 1 the "cumulative" effect from my spondylosis with myelopathy (condition?)
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I NOW have “burning” nerve pain symptom’s location:
1-BOTH Pinkies have INCREASED level of “burning” pain
2- NEW AND ADDITIONAL “burning” nerve pain symptoms in the ENTIRE dorsal ulnar cutaneous distribution in BOTH my left and right hands extending THRU-OUT the entire sensory territories of the ulnar portion of the posterior aspect
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I have “Numbness” symptom’s location:
1- Complete in the BOTH hand’s “Outer Palm”
2- ALSO both Outer Palms NOW have “burning” nerve pain symptoms
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THANKS
doctor
Answered by Dr. Bruno Mascarenhas 19 hours later
Brief Answer:
4 Questions have been answered

Detailed Answer:
QUESTION 1: What could explain this "rapid" spreading in the location and intensity of these symptoms??
Answer 1 : Compression

QUESTION 2: If the C4-7 POSTERIOR LAMINECTOMY AND FUSION surgery been performed on March 1, would it have PREVENTED these symptoms from "spreading"? Please Explain
Answer 2 : This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now

QUESTION 3: the fact that the Hard Collar with it's adjustable chin support gave me "Relieve" from "burning" nerve pain from February 1 thru March 1 and then it's "effectiveness" Decreased from March 1 thru April 1 as the nerve pain and numbness symptoms increased suggest that if the surgery with fusion had been performed on March 1, that the surgery with fusion would have stabilized my condition and prevented the nerve pain and numbness symptoms from spreading?
Answer 3 : This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now

QUESTION 4: is spondylosis with myelopathy, A syndrome, condition or disease?,
Answer 4 : Can you please tell me what is your definition of Syndrome, Condition, Disease. Different people use these terms with different meanings. Hence I want to be sure


Question 5 :
I am not able to understand this question
Please rephrase it




Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Bruno Mascarenhas 3 days later
QUESTION 2: If the C4-7 POSTERIOR LAMINECTOMY AND FUSION surgery been performed on March 1, would it have PREVENTED these symptoms from "spreading"? Please Explain
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YOUR ANSWER:
Answer 2 : This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now
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MY FOLLOW UP: Come on, Give it your best theoretical answer!
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QUESTION 3: the fact that the Hard Collar with it's adjustable chin support gave me "Relieve" from "burning" nerve pain from February 1 thru March 1 and then it's "effectiveness" Decreased from March 1 thru April 1 as the nerve pain and numbness symptoms increased suggest that if the surgery with fusion had been performed on March 1, that the surgery with fusion would have stabilized my condition and prevented the nerve pain and numbness symptoms from spreading?
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YOUR ANSWER:This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now
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MY FOLLOW UP: Come on, Give it your best theoretical answer!
doctor
Answered by Dr. Bruno Mascarenhas 22 hours later
Brief Answer:
Consultation is for Medical Opinion. Not for Speculations

Detailed Answer:
//MY FOLLOW UP: Come on, Give it your best theoretical answer!//
This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now

//MY FOLLOW UP: Come on, Give it your best theoretical answer!//
This cannot be answered now. It is not possible to analyse decisions taken at an earlier stage now

Use of Words like "Come on" by the patient are not appropriate in a professional consultation. This shows that you are not giving due importance to your health and dealing with your health in a very casual manner, which is perhaps the reason for your problems


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
Dr.
Dr. Bruno Mascarenhas

Neurologist, Surgical

Practicing since :2000

Answered : 806 Questions

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