Viewing 6 posts - 1 through 6 (of 11 total)
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  • geno71
    Participant
    Post count: 5

    Hi,

    I’m a 35 yr old male and have been experiencing a chronic low grade neck pain and stiffness over the last year. This whole episode seemed to start randomly. There was no injury or trauma leading up to it. I do work in the computer field and so repetitive injury/posture issues can definitely be involved. In December of 2014, I had experienced a sharp pain in my left shoulder with pain and numbness radiating into my left arm and hand. I also had pain between the shoulder blades. This initial pain was fairly intense, but I had no neck pain at this point. An MRI was performed and showed minimal diffuse disc osteophyte complex at c5-c6. I had undergone some Chiropractic care and took some OTC meds and the numbness/pain in the shoulder/arm/shoulder blade subsided after a month or so.

    Since that time (February 2015) I have been dealing with the neck pain which feels mainly like sore/strained muscles. After the condition did not improve over a few months, I went to the Orthopedic dr in June 2015. He reviewed the MRI from Dec 2014, and concluded I had a disc bulge at c5-c6. He prescribed 10 days oral prednisone and 8 weeks physical therapy. I definitely felt improvement after 3 days on the prednisone and by the time I was done with physical therapy, I’d say there was substantial improvement in my pain level (from a 3/4 to 2/3). However I was plateauing and the pain has been about the same since I finished PT in August 2015. The Orthopedic dr thinks that I could be dealing with facet arthritis, but I wanted to get your thoughts. One thing I notice is that the pain is better in the morning and gets worse through the day. The pain is also better on the weekends (when I’m not working) than during the week. I’ve been doing my best to watch my posture, adjust my workstation, take breaks, stretches, etc but overall my neck just feels achey and sore. I just had another MRI this month to see if there were any significant changes but the only finding mentioned was slight straightening of the cervical spine. I have included my radiologist reports below and appreciate any insights you might be able to provide.

    MRI 12/22/2014

    FINDINGS:

    The cervical curvature, the heights of the vertebral bodies, the alignment, and the disc spaces are normal. The C1-C2 articulation and the facets are normal. No tonsillar herniation. The cord is of a normal signal intensity. At the C5-C6 level minimal diffuse disc osteophyte complex resulting in partial effacement of the anterior subarachnoid space and minimal narrowing of the intervertebral foramina bilaterally is noted. No evidence of cord compression. The C6-C7 level is normal. The rest of the examination Is unremarkable. The paravertebral soft tissues are normal. No obvious mass lesion is present

    IMPRESSION:

    1. MINIMAL LOCALIZED CERVICAL SPONDDYLTIC CHANGES C5-C6 WITH PARTIAL EFFACEMENT OF THE SUBARACHNOID SPACE AND NARROWING OF THE INTERVERTEBRAL FORAMINA BILATERALLY WITHOUT COAD COMPRESSION.
    2. THE REST OF THE EXAMINATION IS GROSSLY UNREMARKABLE.

    MRI 2/15/2016

    FINDINGS:
    There is slight straightening of the normal cervical lordosis. No significant spondylolisthesis is seen. Vertebral body heights are maintained without evidence of fracture. Bone marrow signal is within normal limits with no discrete osseous lesions seen. lntervertebral disc space heights are well-maintained. The craniocervical junction is unremarkable. The cerebellar tonsils are not low lying. The occipital condyles are intact. The cervical cord is normal in caliber morphology. No definite cord signal abnormality is seen. No significant degenerative changes are seen. There is no evidence of significant central canal stenosis or neural foraminal narrowing. The paravertebral soft tissues are grossly unremarkable. The vertebral artery flow voids are present.

    IMPRESSION:

    Slight straightening of the normal cervical lordosis which may be secondary to muscle spasm or patient positioning. Otherwise unremarkable examination.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You should find it interesting that your MRI in 2016 notes “No significant degenerative changes are seen” even though the MRI in 2014 noted “the C5-C6 level minimal diffuse disc osteophyte complex resulting in partial effacement of the anterior subarachnoid space and minimal narrowing of the intervertebral foramina bilaterally is noted”. This shows you the inconsistency in radiological readings as degenerative changes in 2014 will never improve in subsequent MRIs. It is all in the eye of the beholder so your 2016 reading is suspect.

    It is uncommon for facet disease that is present to be noted by radiologists who are sometimes untrained to identify degenerative facet findings. That is, degenerative changes might be present but unappreciated.

    Your pain could be discogenic in nature as flexion activities (bending forward) will load the disc and unload the facets. Nonetheless, facet pain can also occur with flexion. A careful examination with deep facet palpation might yield the clue as to the pain source. If deep palpation of the facets reproduces your pain, you would be a candidate for cervical facet blocks (probably of C5-6). If the disc is a pain generator instead, epidural steroid injections would be indicated. All of this along with therapy provided by a well-trained physical therapist.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    geno71
    Participant
    Post count: 5

    Hi Dr. Corenman,

    Thank you for your reply. I did find it interesting how the most recent MRI seemed to be “better” than the one from 2014. As you said, it’s all about the interpretation of the person viewing the images. One thing I did not mention in my initial post is that the pain is more pronounced on the right side of my neck. If I press on the right side of the lower part of my neck with decent pressure I can feel some soreness/tenderness there. At this point I plan to follow up with a pain management specialist, but in the meantime I’ve posted links to the actual MRI images if you might be able to weigh in on them. There were some X-rays done in Dec 2014 which I also included in the links below. I greatly appreciate your insights.

    2-15-2016

    https://www.dropbox.com/sh/gz75gt5341n2mfv/AAAs69BkSBdqYMlqMXk3nBJoa?dl=0

    12-22-2014

    https://www.dropbox.com/sh/rwma0eo3o8vkpu4/AABKcl2BT7wPxwjD6LF_RLrca?dl=0

    Thanks
    Josh

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Unilateral neck pain (one-sided) is more likely to be facet than disc generated. Sorry, but I cannot open images on this site for fear of viruses. A pain management doctor is a good idea.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Sorry I had to delete the images but there is identifying information on them and this has to be an anonymous site. I cannot generally look at selected images but need to see the entire series of MRI images (normally about 130 images) to be able to discern any particular pathology. This then is added to X-ray images including flexion/extension views to allow a relatively complete imaging profile.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    geno71
    Participant
    Post count: 5

    Hi Dr. Corenman,

    I’m still having the same constant low grade neck pain that I reported on here over a year ago. It’s still primarily on the right side mid to lower neck, but I’ve also noticed tenderness if I press on the spinous process around the c5-c6 area. The pain is better but not completely gone in the morning when I first wake up. The pain gets worse as the day goes on. At times, the pain seems to radiate into the tops of my shoulders on both sides. Bending my head backward seems to produce pain more so than bending forward.

    I’ve been to a few different pain doctors in the past year, but really haven’t been given a diagnosis if it’s facet or disc related. Since I last posted, I’ve been prescribed Meloxicam which I took for a month as well as Skelaxin and Flexeril which offered no relief.

    I’ve been to three different pain doctors and none of them felt like the facet joints were the issue. The most recent doctor prescribed a Medrol pack for a week which made no difference. He now would like to proceed with a cervical epidural instead of facet block based on the fact that it’s highly unlikely for me to have facet arthritis at age 37 without any prior trauma and that my original issue in 2014 involved left sided shoulder and arm pain/tingling which is more indicative of a disc problem. I wanted to get your thoughts on this approach.

    Here is my most recent mri and extension/flexion X-rays performed on 9-23-17.

    Comparison:
    Previous MR cervical spine from 02/15/2016.

    Technique:
    MRI of the Cervical Spine without contrast:
    T2/STIR fat saturation sagittal, T1 sagittal, T2 FSE axial, and 3D gradient echo axial imaging sequences were performed through the cervical spine.

    Findings:
    Craniocervical junction: No significant abnormalities are detected of the clivus or cervicomedullary junction. The cerebellar tonsils are normal in position. The foramen magnum is patent. The atlantoaxial articulations are unremarkable.
    C2-3: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebra) joint or facet arthrosis. Neural foramina patent. The central canal is normal.
    C3-4; Mild right-sided annular disc bulging. No focal disc herniation. The neural foramina are patent. The central canal is normal.
    C4-5: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.
    C5-6; There is mild circumferential annular disc bulging. There is normal disc height. There is no focal disc herniation demonstrated. The neural foramina are patent. There is no central canal stenosis.
    C6-7: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.
    C7-T1: Normal disc hydration and disc height. No focal disc protrusions. No significant uncovertebral joint or facet arthrosis. Neural foramina patent. The central canal is normal.

    Alignment: There are no significant alignment changes from the prior examination.
    Osseous structures: There are no acute osseous abnormalities or bone marrow abnormalities demonstrated in the cervical spine.

    Cervical cord: There are no cervical cord abnormalities.

    Paraspinous soft tissues: There are no significant parasplnous soft tissue abnormalities demonstrated.

    IMPRESSION:
    There are no significant MR abnormalities in the cervical spine for age. There are no significant interval changes detected in comparison to the previous February 2016 cervical spine MRI examination.

    EXAM: XRAY SPINE CERVICAL 6 OR MORE VIEWS

    No relevant prior examinations.
    Technique:
    7 radiographic views of the cervical spine were performed, to include flexion and extension.

    Findings

    Osseous structures: There are no acute fractures or acute osseous abnormalities demonstrated in the cervical spine.
    Alignment; The alignment of the vertebral bodies of the cervical spine is normal, including in flexion and extension.
    Bone mineralization: The bone density of the cervical spine is normal.
    Intervertebral discs and facet joints: The interveriebral disc spaces are preserved. The facet joints demonstrate no significant abnormalities.
    Soft tissues: The prevertebral soft tissues are unremarkable.

    IMPRESSION:
    There are no acute fractures or acute osseous abnormalities demonstrated in the cervical spine. There are no significant, abnormal degenerative findings demonstrated for age.

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