Cervical myelopathy
Short summary
Female patient suffered an episode of sudden shooting pains in her hands while swimming. Since this episode, there has been a progressive improvement. However, the patient still suffers from hypersensitivity in her arms, together with hyperesthesia manifesting predominantly in her hands. For 3 years, the patient has suffered from paresthesia and burning sensations in her arms. Her MRI found marked degenerative differences with spinal narrowing and protruding discs causing pressure on the spinal cord. Spinal cord irregularities found at C5-C6 level. Additional imaging found C3-4 disc herniation with stenosis and C5-6 stenosis with myelomalacia, and a diagnosis of cervical myelopathy was established. The recommendations include anterior endoscopic foraminotomy, spinal cord decompression, and partial discectomy.
Patient's questions
Information about the diagnosis and the patient condition as well as treatment recommendations are required.
Medical Background
Below are the test results from an MRI of the cervical Under “results” spinal column
Test was done with T1, T2 weighting
Reason for Referral:
Paresthesia and numbness in legs, and burning sensation in arms Suspected cervical myelopathy.
Results:
Marked degeneration in the bony structure, reduction in the intervertebral spaces, with modic changes around the intervertebral spaces and OPLL at C3-C4-C5 level.
Narrowing of the spinal canal was seen at level C3-C4-C5. Acute angulation of the cervical spinal column was also noted at these levels.
Cervical intervertebral foramen within normal limits. No prolapse of cerebellar tonsil through the foramen magnum.
Pressure on the spinal cord at levels C3-C4-C5-C6. Abnormalities found at C5-C6 level, which could prove to be myelopathy.
Each intervertebral space was analyzed individually:
C1-C2 – Within normal limits.
C2-C3 – Within normal limits.
C3-C4 – Noticeable OPLL, with protruding intervertebral disc causing pressure on dural sac. Light pressure seen on the spinal cord, and narrowing of the intervertebral foramena bilaterally.
C4-C5 – Central hard disc prolapsed to the posterior, causing pressure on dural sac and light pressure on the cord.
C5-C6 – Diffuse bulge of the disc, causing pressure on dural sac and pressure on spinal cord. Cord looks unusual, and neural foramena bilaterally narrowed.
C6-C7 – Diffuse bulge of the disc causing pressure on dural sac, unlikely to have pressure on spinal cord. Neural foramena normal.
C7-D1 – Within normal limits
Synopsis:
Marked degenerative differences seen, with spinal narrowing and protruding discs causing pressure on the spinal cord. Spinal cord irregularities found at C5-C6 level.
Medical opinion
Cervical Myelopathy
Chief Complaint: “Burning” pains in arms, more severe towards the little finger, worse on the left side.
History of Current Complaint: 10 days ago, the patient suffered an episode of sudden shooting pains in her hands while swimming. Since this episode, there has been a progressive improvement. However, the patient still suffers from hypersensitivity in her arms, together with hyperesthesia manifesting predominantly in her hands. For 3 years, the patient has suffered from paresthesia and burning sensations in her arms.
General Patient History: Generally healthy
Medications: Cipralex
Allergies: None known
Physical exam: Within normal limitations
Neurological exam: Good reflexes from brachioradialis and inferior. Patient tested positive bilaterally for tremor and Hoffmann’s sign. Babinski’s reflex and clonus tested negative. Tandem normal.
Imaging: C3-4 disc herniation with stenosis, C5-6 stenosis with myelomalacia
Diagnosis: Cervical myelopathy
Recommendations: Right C5-6 anterior endoscopic foraminotomy and spinal cord decompression
Second stage: Right C3-4 C4-5 anterior endoscopic foraminotomy and partial discectomy
During the meeting, the procedure was described to the patient, including potential complications.
Pre-surgery tests required: Blood count, chemistry, coagulation functionality, chest x-ray, EKG.
