[susies1955]

#5240

I have had chronic neck and back problems since my early 20’s. I’m now 56. I FINALLY got MRI’s and Xrays. I have the MRI’s on disc and the written reports.
I have seen a Neurosurgeon and he suggested PT and I’m to have an EMG with Nerve Conduction Study done Jan. 5h. He said if a lot of nerve damage is found he will want to replace the three disc and fusion. The surgeon also said that the instability was a LOT worse than the written report.

My symptoms are:
Burning feelings at base of neck (this gets a tad worse later in the day), left shoulder periodically, bicep (mostly left) and numbness in thumb, index and middle fingers but only at night while sleeping. None of these symptoms are unbearable.
The PT is making my neck much stronger. I can tell when I tip my head back I feel I have much more control now.
My back pain comes and goes but I do ok with it.
My questions are:
Do you think the PT will fix the instability or at least it will help it?
Do you think that surgery will be necessary? I am SO against having it.
Do you have any advice for me? Any comments?
We ride Harley about 10,000 miles every summer. Do you think I will be ok to continue this?

Here are my MRI and Xray written results:
NECK MRI:
Minimal grade I retrolisthesis of C5 on C6 is noted. There is a very mild kyphotic curvature of the cervical spine. Disc dessication is seen throughout with mild loss of the disc height at C4/5, C5/6 and C6/7. No oseous lesions or osseous edema noted.
C2/3 demonstrates no significant findings.
C3/4 there is a minimal central disc bulges without spinal or foraminal stenosis.
C4/5 demonstrates a mild diffuse disc osteophyte complex with mild spinal stenosis. There is no significant foraminal stenosis.
C5/6 demonstrates a mild to moderate diffuse disc osteophyte complex with mild to moderate spinal stenosis. There is moderate bilateral foraminal stenosis.
C6/7 demonstrates a mild disc bulge without significant spinal or foraminal stenosis. The cervical cord is normal in signal intensity.
IMPRESSION: Degenerative disc disease as described, most prominent at c5/6 where there is mild to moderate spinal stenosis and bilateral mild to moderate foraminal stenosis. No cord compression or cord edema.

NECK XRAY:
There is mild grade I retrolisthesis of C5 on C6. There is moderate degenerative disc disease at C5/6 and C6/7. There is no acute fracture of dislocation noted. Flexion views reveal stable retrolisthesis of C5 on C6 however, there is mild increase in the retrolisthesis on extensions at this level. There is no prevertebral retrolisthesis on extension at this level. There is no prevertebral soft tissue swelling. Oblique views of the mild bilateral foraminal stenosis at C5/6 and mild left foraminal stenosis at C6/7 his is due to degenerative disc disease and uncovertebral joint hypertrophy.
IMPRESSION: No acute finding. Degenerative changes are seen in the cervical spine with retrolisthesis of C5 on C6 which is a bit worse with extension. Degenerative disc disease as described with mild foraminal stenosis.

BACK MRI:
There is subtle grade I spondylolisthesis of 5 on 1. This appears to be related to bilateral small pars defects at the L5 level. No focal herniations are identified. No intraosseous lesions noted. Sub-articular fat planes appear normal.
IMPRESSION: 5 on 1 spondylolisthesis which is very minimal and grade I related to bilateral defects.
Thanks for your help.
Susie

[Donald Corenman, MD, DC]

#5241

There are two ways to look at symptoms- one by using the complaints to determine what differential diagnosis could be causing symptoms and the other by using the imaging to determine what symptoms could be generated by the findings. We will do both.

First- symptoms you complain of. Moderate burning at the base of your neck that increases slightly as the day wears on, occasional burning in your left shoulder and numbness in the first three fingers only at night. You have undergone PT with increased strength but no change in symptoms. Burning at the base of the neck is typically from degenerative disc disease but facet disease can also cause this. Intermittent pain in the left shoulder could be from referral from the neck (the C5 or C6 nerve) but occasionally, at your age could also be from the shoulder (rotator cuff syndrome).

The hand symptoms could be from the C6 or C7 nerve but with only night symptoms, more likely this could be from carpel tunnel syndrome where the median nerve becomes compressed by wrist flexion at night. A simple test to confirm this diagnosis is to wear a cock-up splint on that hand while sleeping. You can ask your surgeon for a script or simply purchase one at a local pharmacy.

Now- by going through your MRI, this notes multilevel degenerative changes of the discs. Your worst level is C5-6 where there is some central stenosis and bilateral foraminal stenosis. This means there is come compression of the nerves that exit here (C6 nerves) and some compression where the spinal cord lives. By your complaints, you might have some irritation to your nerves but you don’t have complaints of cord compression (balance problems, problems with dexterity or lightening type symptoms in your spine). You have not noted weakness in your arms.

The EMG test can uncover carpel tunnel syndrome but may not show anything else. Flexion/extension X-rays of the neck are very useful to demonstrate instability and could be performed if your surgeon thought they would be helpful.

Surgery is necessary for five reasons, pain that is not tolerable, compression of the nerves that cause motor weakness, cord dysfunction from compression, deformity that can be expected to continue or prevention of cord injuries if the patient has significant central spinal stenosis and participates in activities that put the neck in jeopardy (skiers, mountain bikers, contact sport players with significant spinal stenosis). Do you fit any of those indications?

For your lower back, this condition (isthmic spondylolisthesis) is normally painful but not dangerous. Therefore, if you can live with the pain and have no motor weakness (typically foot drop), surgery is only one option. Please see the segment on isthmic spondylolisthesis for a good explanation.

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.

[susies1955]

#5242

Dr, Corenman,
Thanks for your reply.
Two symptoms I missed. I do have burning in my biceps at times and normally in my left one. I also have tinnitus now.
I don’t have any weakness that I know of and there have been a few times out of all these years that I felt out of balance but I don’t know if it is related.
The only thing I do that would be anything to put my neck in jeopardy in my opinion is Harley riding. We ride all day and I have the helmet on which is rather heavy at almost five pounds. Sometimes there may be a pot hole we hit and it can really make my neck burn. It feels like I have no cushioning when that happens.
I appreciate your help and it will be interesting to see what the EMG/Nerve Conduction Study shows and what Dr. Montgomery thinks about it all. I will certainly get a second opinion if he suggest surgery. I’m thinking/praying he won’t. :)
Susie

[Donald Corenman, MD, DC]

#5243

Burning in the biceps could indicate pain from the C6 nerve. If the pain is worse with neck extension (bending the head backwards), this could indicate pain from foraminal stenosis. Balance issues would be much more frequent than you describe for myelopathy to be present. The pain when going over a bump while helmeted and riding the Harley is most likely from the C5-6 disc but could be from others too (you should be commended for using a helmet).

Good luck.

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.

[susies1955]

#5244

Thanks! You have been very helpful. :)
Susie

[susies1955]

#5245

Dr. Corenman,
I wore the splint on my right hand while sleeping last night and NO numbness happened. At least that relieves my mind that it’s not from nerve damage from my neck.
Seeing it only happens at night is there any harm in just letting it be?
Thanks again,
Susie

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