Wondering and Trying to Educate

[SirBudLuvR]

Good Day All,

I have had ongoing spinal issues for just over 20 years. Currently they want to do surgery on my neck due to Myelomalacia. Since I was told that (03-23), I have had some sudden changes that seem, to me anyway, to be of significance. Par for my personal life story, Doctors appear nonchalant in regards to these sudden changes.

About four (4) months ago I woke up one morning unable to use my left hand and limited range of motion in left arm. I am awaiting new MRI on neck but I have had a new EMG. In that EMG it states that ".... left ulnar F wave is absent." ABSENT ....... when I research an absent F Wave, I see tons of stuff in which ALS seems to be the prevalent topic. Many ALS symptoms could be seen in my Med. History but that could be subjective in my case.
Does the absence of the F Wave give any of you guys pause .?..?? Is it just a Red Herring .?..??


Please and Thank You for your time & consideration on the matter.....Mark~

 

[ShiftKicker]

Hi Mark-

Feel free to post the EMG report summary. This provides a bit more info.

 

[lgelb]

A few ALS patients have an absent ulnar F wave. So do a few patients with various other neuronopathies, myopathies, GBS, thyroid dysfunction, and lots more with peripheral neuropathies. Etc.

Spinal nerve damage, including damage to the nerves in the neck that control the movement of the arms, is a major cause of myelomalacia and is obviously also a major cause of arm movement issues that are not musculoskeletal.

I always recommend a second opinion on spinal surgery, at a different center.

 

[SirBudLuvR]

Please and Thank You ShiftKicker .!..!!

Findings:

Straightening of the normal cervical lordosis which can be related to muscle spasm or positioning. The vertebral body heights are maintained. No bone marrow edema or marrow replacement process is seen.

There is multilevel advanced degenerative disc disease most prominent at C5-C6 and C6-C7 with disc desiccation
and disc height narrowing. Bridging anterior marginal osteophytes at C4-C5 through C6-C7.

Atlantooccipital articulation DJD.

No masslike process within the spinal canal. Possible small focus of T2/STIR bright signal posterior to C6.

The spinal cord signal otherwise demonstrates normal signal intensity. The craniocervical junction and prevertebral soft tissues are within normal limits.

The thyroid is symmetric. The normal vascular flow voids are visualized. No suspicious soft tissue abnormality is
detected.

Level by level:

C2-C3: Mild disc bulge and facet hypertrophy. Mild spinal canal stenosis. Mild bilateral neural foraminal narrowing.

C3-C4: Disc osteophyte complex and facet hypertrophy. Mild spinal canal stenosis. Moderate to severe left-sided and
moderate right-sided neural foraminal narrowing.

C4-C5: Disc osteophyte complex and facet hypertrophy. Mild to moderate spinal canal stenosis. Moderate to severe
bilateral neural foraminal narrowing, left greater than right.

C5-C6: Disc osteophyte complex and facet hypertrophy. Disc osteophyte is eccentric to the right causing focal moderate
spinal canal stenosis. Moderate to severe bilateral neural foraminal narrowing.

C6-C7: Disc osteophyte complex and facet hypertrophy. Mild spinal canal stenosis. Moderate bilateral neural foraminal
narrowing.

C7-T1: No significant disc bulge, spinal canal stenosis or neural foraminal narrowing.


Impression:

1. Multilevel degenerative changes of the cervical spine as discussed in detail above.

2. C5-C6 disc osteophyte complex which is right eccentric resulting in focal moderate spinal canal stenosis. Small focus
of T2/STIR bright signal within the spinal cord at this level suspicious for myelomalacia.

Electrophysiological results reveal:

1. Motor testing including the median nerve shows normal CMAP amplitude, latencies and conduction
velocities bilaterally. Right ulnar nerve with normal responses. Left ulnar nerve with reduced amplitude,
normal latencies and conduction velocities. However, left ulnar nerve unrecordable proximally at the
erb's point, possibly technical. Right ulnar F-wave is normal, left ulnar F wave is absent.

2. Sensory testing including the median, ulnar and radial nerves show normal SNAP amplitudes and
conduction velocities bilaterally. LAC and MAC with normal responses compared side-to-side.
The needle EMG of select muscles on the bilateral upper extremities and cervical paraspinal muscles
shows positive waves and fibrillation potentials over the left deltoid and FDI muscles.
Increased insertional activities noted over the left biceps. Activation shows severely reduced recruitment of
normal-appearing motor units over the left FDI muscle.

Interpretation

In summary, the electrodiagnostic test shows evidence of subacute mid and lower cervical radiculopathy
on the left side. All of his sensory potentials including LAC and MAC are normal which excludes possibility
of brachial plexopathy. Clinical correlation is recommended.

 

[lgelb]

Clearly, you have cervical spine damage. The surgical justification/plan would require more than this EMG and imaging can show, of course, such as findings from exams (that's what "clinical correlation" refers to).

I'll continue to suggest a second opinion before agreeing to any spine surgery, which can have lifelong consequences. But there's no reason to worry about ALS here.

 

[SirBudLuvR]

I concur. Just not enough evidence. I am of the mind there is a mechanical compression issue involving cervical plexus CNX and CNXI. This theory would explain the last two decades. But what do I know, I am not a doctor I have just lived it for 20+ years and happen to study, educate myself.
…… sorry just tired of the indiscriminate judgment in the medical world …. hell, in the World.

(just one Man’s opinion)