[vijay]

#4818

Hi Doctor,

I am suffering from severe neck pain for the past 4 months. My diagnosis is as follows:

C4-C5 Right posterior Osteophyte Complex seen causing right C5 nerve root compression.

C5-C6 Mild postro central bulge seen indenting on thecal sac.

My condition is not getting better with time. Please suggest a further course of treatment

Please let me know if i need to provide any additional info.

Thanks in advance

[vijay]

#4819

My symptoms:

1. Difficulty in swallowing solid food.
2. Acute pain in the neck and shoulder blade.
3. Difficulty walking with head held straight.

[Donald Corenman, MD, DC]

#4822

Your MRI findings are not your diagnosis but the physical disposition of your neck. You note acute pain in your neck and shoulders. How would you differentiate your neck versus shoulder pain? Is it 50% neck and 50% shoulder pain or more in the neck or shoulder? 60/40, 80/20, 30/70 neck versus shoulder. The percentage of pain from right to left can be helpful.

Do you have any tingling (paresthesias) in your arms or hands? Does the neck pain or shoulder pain become more intense when you bring your head up to neutral versus keeping it bent forward?

The MRI report notes a “bulge” at C5-6 “indenting” the thecal sac. Does this also compress the spinal cord? I would assume not but I don’t necessarily always believe what the radiological report states. You do have C5 nerve root compression according to the report. This would cause pain to radiate into the top of the right shoulder and possibly cause deltoid weakness (weakness with lifting up the arm at the shoulder). Bending your head backwards would cause further compression of this nerve root and more pain. In contrast, keeping your head bent forward will relieve some root pressure and consequently, there will be less pain.

Difficulty swallowing food is normally not associated with neck disorders unless you have developed a bone spur so large that it presses on your esophagus (very rare- I have seen only one case in my career).

Depending upon the correct diagnosis- if you really suffered from C5 nerve compression and had no significant deltoid muscle weakness, you could consider an epidural steroid injection or selective nerve root block (see website for discussion of these) along with some physical therapy. If that was not effective, an ACDF (anterior cervical decompression and fusion) would be the next step.

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.

[vijay]

#4823

Hi Doctor

Thanks for the reply

The pain is 70/30 neck / shoulder and more on the right shoulder.
There is no tingling sensation but as informed by you pain is more intense when head is in neutral (looking straight) or bent backward.

Should I go to a specialist for the swallowing issue.

Regarding the steroid injection how does this work ie., is it a pain reliever or it treats the cause.

Further I hear that the long rest of 6 to 8 weeks would make me better is this true ?

Regards

[Donald Corenman, MD, DC]

#4826

You have more neck than shoulder pain. The pain increases with neutral head position and further increases with extension (bending the head backwards). You do not mention shoulder (deltoid) weakness so I will assume there is no upper extremity weakness. You also do not mention imbalance, problems with your hands involving fine motor skills, lightening type sensations down the spine and extremities and bowel/bladder symptoms so I will assume there is no spinal cord compression.

The steroid injection is not a pain killer. The steroid reduces inflammation and strengthens the nerve membrane so it is therapeutic. This injection can change the nerve environment and can give long lasting relief. The steroid injection will do nothing for motor weakness however.

Rest by itself for 6-8 weeks would not be recommend as your neck muscles can become deconditioned. You do need to avoid the positions of your neck that cause pain so wearing a soft collar may help you. Physical therapy can be helpful and is recommended.

The swallowing difficulty should be worked up by a specialist such as an ear-nose-throat doctor (ENT).

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.

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