instruction: hello doctor I am a female 30 years old questions how and why do I have all symptoms of ca radiculopathy confirmed by egg but not reflective of mri ca to normal what else if anything could cause ca radiculopathy in last digits per my imaging that would explain this medically what is your final assessment and why to date undergone much it and received facet injections at sites above and below acdf persistent neck pain into scapula and upper extremity unilateral hand numbness especially d4 d5 now with new weakness in opposite hand history background diagnostics former acdf at c5 labeled degenerative disk in mid late 20 resulted in great success post surgery several years later accident occurs results multiple levels damaged cervical spondylosis imaging reports mri findings no cord vertebral lesion and multi below above acdf ca herniation and degeneration and cord encroachment c5 ca bony overgrowth causes cord encroachment ca herniation degeneration but without any encroachment ca to unremarkable mydlo gram showed small extradural lesion at c5 with thecar sac compression a spur projecting from posterior border of ca small ventral defect egg left ue neuro exam weakness adm apb est do decreased sensation digits 4 clawing in ith digit der ncv left ulnar sensory nerve decreased conduction veloc wrist ith digit 42 polyphasic volition est do and adm no acute radiculopathy plexopathy peripheral neuropathy final abnormal test concluded chronic ca radiculopathy
output: hi you do have chronic ca radiculopathy from your detailed description the reason for mismatch between nav egg findings and mri can be explained on the basis of a pre fixed or a post fixed brachial plexus where in the nerve exiting the c7 to inter space is actually carrying nerve fibres from the space below that will show up normal on mri the actual ca fibres are going out at a space above ie ca c7 or higher where they are getting compressed spur and compression exists at a higher level the second possibility is that there is arachnoiditis but that should show up on mri however I have not seen the mri myself and have to rely on the report the third explanation is possible injuries scarring at the time of acdf or after less likely as you would have known the temporal sequence of symptoms by apb you mean abductor and not abductor pollicus brevis that is median nerve appearance of new symptoms and persisting neck pain alert acdf suggests instability at another level which unfortunately can happen and is a collateral effect of fusion in spine get flexion extension rays and dynamic contrast mri